Incident and long-term HIV-1 infection among pregnant women in Brazil: Transmitted drug resistance and mother-to-child transmission

Abstract

Primary infection, seroconversion, and transmitted drug resistance (TDR) during pregnancy may influence the risk of mother-to-child-transmission (MTCT) of HIV-1 infection. This study estimated recent seroconversion, TDR rates, HIV-1 subtypes and pregnancy outcomes among 95 recently diagnosed, antiretroviral (ARV)-naïve pregnant women recruited during antenatal care in central western Brazil. Recent seroconversion was defined by BED-capture enzyme immunoassay (<155 days) and ambiguous nucleotides base calls (<1 year) in pol sequences (protease-PR and reverse transcriptase-RT regions). TDR was evaluated by the Calibrated Population Resistance tool. HIV-1 subtypes were defined by REGA and phylogenetic analyses. The median age of participants was 25 years; the median gestational age at diagnosis was 20.5 weeks. Based on serology and sequence polymorphism, recent infection was identified in 11.6% (11/95) and, 9 of them (82%), probably seroconverted during pregnancy; one MTCT case was observed among them. Three cases of stillbirth were observed among chronic infected patients (3.6%; 3/84). Moderate rate of TDR was observed (9/90, 10%, CI95% 4.7-18.1%). Subtype B was 60% (54/90), 13.3% (12/90) was subtype C, 6.7% (6/90) was subtype F1. Recombinant B(PR) /F1(RT) and F1(PR) /B(RT) viruses comprised 15.5% (14/90); B(PR) /C(RT) mosaics represented 4.4% (4/90). Seroconversion during pregnancy, late presentation to antenatal care and moderate TDR identified in this study represent significant challenges for the MTCT elimination. J. Med. Virol. 88:1936-1943, 2016. © 2016 Wiley Periodicals, Inc.

Characterization of HIV-1 CRF90_BF1 and putative novel CRFs_BF1 in Central West, North and Northeast Brazilian regions

“…Our studies have shown a significant percentage of recombinant BF1 forms (3.7–25.9%) in the Central West, North and Northeast Brazilian regions [11,27–37]. The most recently described Brazilian CRFs_BF1 (CRF70_BF1 and CRF71_BF1) were identified among blood donors from Pernambuco State, Northeast region [22].…”

“…The importance of BF1 recombinants in Brazil is further corroborated by the description of countless URFs in all country regions [23–26]. Previous studies from our research group in different study populations in Central West, North and Northeast Brazilian States showed variable prevalence of BF1 recombinants in the pol subgenomic fragment: (Goiás: 3.7–18.1%, Mato Grosso: 11.9%, Mato Grosso do Sul: 8.2–25.9%, Tocantins: 7.7%, Maranhão: 7.5%, Piauí: 4.5% [11,27–37]. …”

“…Previous studies from our group recruited from 2003 to 2013 a total of 828 individuals infected with HIV-1 residing in six Brazilian States located in three geographic regions (Central West: Goiás/GO, Mato Grosso/MT, Mato Grosso do Sul/MS; North: Tocantins/TO; Northeast: Maranhão/MA, Piauí/PI) ( S1 Table ) [11,27–37]. These studies have identified a total of 87 (10.5%) BF1 recombinant isolates based on sequencing of pol subgenomic fragment covering the protease (PR) and partial reverse-transcriptase (RT) (positions 2253–3251 relative to HXB2 genome).…”

“…RNA extraction, reverse transcription into complementary DNA (cDNA) and amplification by nested polymerase chain reaction (nested-PCR) of the PR/RT regions were previously described [11,27–37]. …”

Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda

“…Mother-to-child transmission (MTCT) is the primary mode of HIV infection in children either during pregnancy, labor, and delivery or through breast feeding [4–6]. Several studies have proven that antiretroviral drugs decrease HIV transmission from the mother to the baby [7–11]. Particularly, the use of triple antiretroviral (ART) therapy during pregnancy has been proven to be highly effective in reducing mother-to-child HIV transmission from 15% up to 45% with no treatment at all to below 5% [12].…”