10th Anniversary Conference Of The British HIV Association [BHIVA]


15 – 17 April 2004, City Hall, Cardiff, UK


[TITLE:] GENOTYPIC RESISTANCE TO ANTIRETROVIRAL THERAPY IN HIV-1 INFECTED PREGNANT WOMEN TAKING HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) IN PREGNANCY

[AUTHOR(S):] F Lyons1, S Coughlan2, C Byrne2, S Hopkins1, W Hall2, C Bergin1, F Mulcahy1
1 GUIDE Clinic, St James's Hospital, Dublin, 2 National Virus Reference Laboratory, University College Dublin, Ireland

BHIVA Conf 2004 Apr 15-17;10:O12

BACKGROUND: HAART, regardless of maternal need for therapy, reduces mother-to-child HIV transmission. Temporary HAART in pregnancy may provide a predisposition to the emergence of genotypic resistance.

METHODS: Pregnant HIV-1 infected women with a pretreatment CD4 count of >300 cells/µl initiated HAART in the third trimester and discontinued post-partum (n=50). Genotypic resistance testing (RT) (HIV-1 TruGene) was performed after HAART cessation and on pretreatment samples when post-partum samples showed primary mutations. Samples with a viral load (VL) of >500 HIV-1 RNA copies/ml were included.

RESULTS: 39/50 (78%) sequences were available for analysis, 11/50 (22%) were excluded (nine with a VL <500; two with no sequence). 4/39 (10%) took antiretroviral therapy (ART) in a previous pregnancy [one zidovudine (ZDV), two Combivir, one ZDV/Combivir]. Pretreatment parameters: median CD4 480 cells/µl (range 300–1082); median VL 2689 copies/ml (50–34753). HAART regimens: Combivir/nevirapine (NVP) (28), Combivir/nelfinavir (NLF) (10), didanosine (ddI)/ZDV/NLF (one). Median HAART duration: 70 days (3–114). VL at ~36 weeks: 30/39 (77%) <1000 copies/ml; 7/39 (18%) no result as delivered early (six) or failed to attend (one). Median time from HAART cessation to RT 42 days (13–198). Seven primary mutations (V106A (one), Y181C (two), G190A (one), K101E (one), M184V (one), T215S (one) were detected in 5/39 (13%) women. 5/5 were on regimens including NVP and were ART-naïve. 4/5 had no mutations detectable pretreatment (one pretreatment RT not available, VL 83 copies/ml).

CONCLUSION: In this cohort, 13% demonstrated primary genotypic resistance post-partum despite HAART.

PRESENTING AUTHOR: F Lyons

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