Journal
JOURNAL OF CLINICAL VIROLOGY
Volume 54, Issue 1, Pages 15-20Publisher
ELSEVIER
DOI: 10.1016/j.jcv.2012.01.011
Keywords
HIV-1; Mother-to-child transmission; Subtype; Drug resistance
Categories
Funding
- UNESCO AIDS/STD, Brazilian Ministry of Health [310-06]
- MS/MCT/CNPq-SCTIE-DECIT/CT-Saude [022/2007]
- FAPEG [200910267000696]
- CNPq [141820/2006-3, 304869/2008-2]
- HDT/HAA/SUS
- IDP
Ask authors/readers for more resources
Background: A high-coverage public health prenatal program (70,000 women/year) from central western Brazil/Goias State has represented a unique opportunity for the early diagnosis of HIV-1 and implementation of strategies to prevent mother-to-child transmission (MTCT). Objectives: To investigate MTCT among a prospective cohort of HIV-1 infected mothers/exposed infants. Study design: 142 mothers/their 149 infants (2008-2010) were investigated regarding maternal viral load, CD4(+) cell counts, HIV-1 pol sequences; infants' HIV-1 RNA tests (30/120days), sequential anti-HIV-1/2 serology. HIV-1 subtypes were assigned by REGA. Transmitted drug resistance was identified by the Calibrated Population Resistance tool, secondary resistance by Stanford HIV-1 Drug Resistance/International AIDS Society databases. Results: Mothers (median age = 24 years; 25/142 adolescents) were diagnosed during prenatal care (2008-2010) or previously (1994-2007). Recent cases were younger, mostly asymptomatic. Undetectable viremia and MTCT prophylaxis predominated in formerly diagnosed mothers. Recent cases had higher subtype C prevalence. One naive patient had transmitted resistance; ten antiretroviral-experienced patients had secondary resistance: 6 from MTCT prophylaxis, 4 under HAART. Late disclosure of diagnosis, vaginal delivery, breastfeeding, lack of oral zidovudine were observed in the three MTCT cases (3/149; 2.01%). Two of three infected infants harbored subtype C; infected infants/mothers did not have drug resistance mutations. Two of the transmitting-mothers had viremia <1000 copies/ml. Among exposed-uninfected infants the median time to seroreversion was 12 months. Conclusions: In this study delayed disclosure of diagnosis, partial/no preventive measures, drug resistance among asymptomatic women under prophylaxis and MTCT in low viremic mothers raise concerns. The expansion of subtype C infection corroborates surveillance of HIV-1 diversity in this region. (C) 2012 Elsevier B. V. All rights reserved.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available