16th International HIV Drug Resistance Workshop 12-16 June 2007, Barbados

DRUG RESISTANCE AMONG HIV-INFECTED PREGNANT WOMEN RECEIVING ANTIRETROVIRALS FOR PROPHYLAXIS IN LIMBE, CAMEROON

Antivir Ther. 2007; 12:S53 (abstract no. 46)

AD Nkengafac, S Tina, F Sua, T Mason, N Auyuketta and S Oben
Institute of Advanced Medical Sciences, Buea, Cameroon

BACKGROUND: Voluntary counselling and HIV testing has become an integral part of HIV prevention and care programs in many countries in sub-Saharan Africa. A number of interventions offer potential to reduce motherto- child HIV transmission. These interventions, including antenatal and or intrapartum administration of antiretroviral drugs require the integration of voluntary counselling and HIV testing for pregnant women into antenatal care. The study was carried out to quantify primary resistance mutations (PRMs) among HIV-1-infected women receiving antiretroviral therapy (ART) for prevention of mother-to-child transmission (MTCT).

METHODS: Peripheral blood mononuclear cell samples from HIV-1-infected women enrolled in a prospective cohort study in the Limbe PMTCT Treatment Center, South Western Cameroon, were assayed for PRMs. Eligible women were those who gave informed consent. Pre- and post-HIV test counseling was provided to all study subjects. Study participants were those enrolled before February 2005 and diagnosed with HIV-1 infection during the current pregnancy, and who received ART for MTCT prophylaxis and were followed for 6–12 weeks postpartum.

RESULTS: Of 819 women, 198 met the eligibility criteria. At enrollment, 98% were asymptomatic, 62% had plasma viral load <1000 copies/ml, 53% had CD4+ cell count >OR=500 cells/microl, and 78% were ART-exposed (mean duration, 8.0 weeks; 95% confidence interval, 7.1–8.9). The most complex ART regimen during pregnancy was usually (81%) a three-drug regimen [two nucleoside reverse transcriptase inhibitors (NRTIs) + one protease inhibitor or two NRTIs + one non-nucleoside reverse transcriptase inhibitor). PRMs were observed in samples from 19 (16%) of 118 women that were amplifiable at one or both time points [11/76 (14%) at enrollment; 14/97 (14%) at 6–12 weeks]. The occurrence of PRMs was not associated with clinical, immunological, or virological disease stage at either time point, whether ART-naïve versus exposed at enrollment, or the most complex or number of antiretroviral drug regimens received during pregnancy (P>0.1). Of 55 women with amplifiable samples at both time points, PRMs were detected in 11 samples (20%).

CONCLUSION: PRMs occurred among 16.1% of relatively healthy HIV-1-infected mothers from Limbe in the South West Province of Cameroon receiving MTCT prophylaxis.

2007-06-12
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