Viral Suppression and Resistance in a Cohort of Perinatally-HIV Infected (PHIV+) Pregnant Women

Abstract

Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6–21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0–13.6), the median age at sexual debut was 16 years (IQR 14–18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation.

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

“…As observed in previous series, [4][5][6][7][8][9][10][15][16][17] a high percentage of the women were not virologically suppressed when they become pregnant, despite having access to medical care and being engaged in intensive health care programs since childhood. In the mentioned cohorts, the rate of viral suppression at delivery ranged from 41% to 85.7%, and in most cases, it was below 70%.…”

“…Persistent viremia can jeopardize the ART regimen, leading to HIV progression, and eventually facilitating HIV transmission when breastfeeding is considered as an option. Various studies in different settings have described the characteristics and challenges that WLWPHIV face during pregnancy, [4][5][6][7][8][9][10][15][16][17] but the effects of pregnancy on retention to care and the mother's long-term health (eg, treatment adherence, immunovirological situation, and disease progression) have not been properly addressed.…”

“…3 Although the numbers are small, the risk of mother-to-child HIV transmission seems to be higher among WLWPHIV, according to most studies. [4][5][6][7][8][9][10] Pregnancy also represents an opportunity to improve ART adherence and retention in care, due to the combination of frequent visits to health care facilities, contact with multidisciplinary teams, and motivation to reduce the risk of perinatal transmission. However, adherence issues and low retention to care have been reported during postpartum in women living with HIV.…”

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

“…Programmatic data from Haiti demonstrate the positive impact of youth-friendly adolescent HIV services on the proportion of young people initiating ART [56]. A proportion of youth living with HIV in CCASA are already parents [57], most of whom are still being followed at adolescent clinics, where they have, many times, built strong bonds.…”

“…Long duration of ART with exposure to sequential changes in regimens and accumulation of resistance mutations is a special challenge for professionals caring for PHIV young people [57,87,[95][96][97]. Work in CCASA has demonstrated the importance of ensuring a comprehensive approach to adolescent HIV care in which factors affecting treatment outcomes can be identified and addressed before the transitioning process begins [73,78,79].…”