9TH EUROPEAN AIDS CONFERENCE (EACS)
1st EACS RESISTANCE & PHARMACOLOGY WORKSHOP

 October 25 - 29, 2003 Warsaw, Poland

3.4 Resistance Testing in Clinical Practice

 F3/6 - A LONGITUDINAL STUDY ON HIV-RESISTANCE TESTING DURING PREGNANCY
* Liuzzi G.1, Di Giambenedetto S.2, Forbici F.1, Bagarelli A.2, Sette P.1, Visconti E.2, Zaccarelli M.1, Pastore Celentano L.2, Tozzi V.1, Zinzi D.1, Anzidei G.1, De Luca A.2, Antinori A.1, Tamburrini E.2, Perno C.F.1, Cingolani A.2, per il Gruppo Laziale Donne Gravidanza e HIV (G.La.Do.G.HIV)
 
(1) Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani-IRCCS, Roma, Italy,2 Istituto di Clinica delle Malattie Infettive,Università Cattolica S. Cuore, Roma, Italy
 

Objective: To determine prevalence and correlates of genotypic resistance to antiretroviral drugs among pregnant women attending two major reference centers in Rome.

Methods: Behavioural, clinical and treatment data of all HIV positive women who underwent genotype resistance test (GRT) during pregnancy between 1999-2002 were input in database. Patients underwent GRT if: a-antiretroviral naïve; b-restarting HAART after interruption during the first quarter of pregnancy, and c-virological failure.

Results: GRT of 32 patients (group-a=6; group-b=12; group-c=14) were analyzed. Main characteristics: median age =32 years; median previous pregnancies=1.5 (range 1-4); median time of GRT from beginning of pregnancy=120 days; median CD4+ at GRT=370/mm3 and median HIV-RNA=4.22 cp/ml (group-a=3.84; group-b=4.64; group-c=4.01). Only secondary mutations were observed in naïve patients: for Reverse transciptase (RT) V106I, V118I in one patient; for Protease (PR) V77I, L10I in one patient each, L63P, M36I in two. Higher number of mutations was observed in group-c vs group-b both for RT (mean=3.8 vs 1.7; P=0.05) and for PR (mean=5.0 vs 2.3; P=0.007). Single mutations significantly higher in failed patients were: M184V, T215Y/D for RT and V82A, I54V, L63P for PR. A significantly higher HIV-RNA decrease after GRT-guided therapy was found in group-b: -2.67 vs -0.65 cp/ml in group-c, P=0.001.

Conclusions: The interruption of treatment at the beginning of pregnancy is related to a low level of resistance with low rate of primary mutations and better response to GRT-guded therapy. However, the importance of viral replication during interruption over HIV vertical transmission should be matter of debate in the next future.

Presenting Author: MD Giuseppina Liuzzi, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani", Via Portuense 292, 00149, Roma, Italy, Phone: 0039.06.55170364

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