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Swiss Med Wkly. 2019 Apr 4;149:w20059. doi: 10.4414/smw.2019.20059. eCollection 2019 Mar 25.

The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study.

Author information

1
Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland.
2
Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland / Clinical Virology, Laboratory Medicine, University Hospital Basel, Switzerland.
3
Children's Hospital of Eastern Switzerland and Cantonal Hospital, St Gallen, Switzerland.
4
University Women`s Hospital Basel, Switzerland.
5
Department of Infectious Diseases, Bern University Hospital, Switzerland.
6
Department of Obstetrics and Gynaecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.
7
University Children's Hospital Zurich, Switzerland.
8
Laboratory of Virology, University Hospital Geneva, Switzerland.
9
Institute of Medical Virology, University of Zurich, Switzerland.
10
University Children's Hospital, Basel, Switzerland.
11
Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland / Clinical Virology, Laboratory Medicine, University Hospital Basel, Switzerland / Infectious Diseases and Hospital Epidemiology, University Hospital Basel, and University of Basel, Switzerland.

Abstract

AIMS OF THE STUDY:

Combination antiretroviral therapy (cART) has reduced mother-to-child transmissions (MTCT) and improved the prognosis of HIV-infected newborns. However, drug resistance mutations (DRM) in HIV-infected children, either transmitted by MTCT (HIV-tDRM) or selected by suboptimal adherence and drug levels (HIV-sDRM), remain a concern. We sought to determine the rate of HIV-tDRM and HIV-sDRM in MTCT pairs in Switzerland.

METHODS:

We performed a retrospective analysis of prospectively collected clinical data and available stored samples from MTCT pairs participating in the Swiss Mother-Child HIV (MoCHIV) cohort.

RESULTS:

We identified 22 HIV-infected mother-child pairs with delivery between 1989 and 2009 who had 15 years of follow-up (33% white ethnicity). Twenty-one women (96%) were treatment-naïve before pregnancy, 8 (36%) had an unknown HIV status and delivered vaginally, 2 were diagnosed but not treated, and 11 (50%) received antiretrovirals during pregnancy or at delivery, of whom only 6 cases (27%) had cART. HIV subtypes were concordant in all mother-child pairs (subtype B 13/22 [59%]). Using stored plasma (n = 66) and mononuclear cell (n = 43) samples from the children, HIV-tDRM (M184V) was identified in 1 of 22 (4.5%) mothers (1/11 treated, 9%) and was followed by HIV-sDRM at 10 months of age. HIV-sDRM (M184V 23%; K103N 4.5%; D67N 13.6%) occurred in 16/22 (73%) after 4 years, half of whom were treatment naïve. HIV-sDRM were associated with a lower CD4 T-cell nadir (p <0.05) and tended to have higher viral loads and more frequent cART changes.

CONCLUSIONS:

HIV-tDRM were low in this Swiss MoCHIV cohort, making them a minor yet preventable complication of prenatal HIV care, whereas HIV-sDRM are a significant challenge in paediatric HIV care.

PMID:
30946481
DOI:
10.4414/smw.2019.20059
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