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13th International AIDS ConferenceDurban, South Africa - July 9-July 14, 2000 |
Int Conf AIDS 2000 Jul 9-14; 13:20 (abstract no.. LbOr16)
Gingelmaier A, Eberle J, Kaestner R, Knobbe A, Dathe O, Guertler L, Stauber M, Grubert TA
I.Frauenklinik der Universitaet Muenchen, Munich, Germany, E-mail: gingelmaier@usa.net.
BACKGROUND: The aim of this study was to determine if or to what degree genotypic resistance testing in pregnancy is useful concerning the therapeutic control of the anti-retroviral drug therapy to avoid a vertical transmission. A second goal was to investigate the prevalence of anti-retroviral drug resistances of pregnant patients naive to therapy.
METHODS: The study represents a retrospective analysis of 45 female patients who had 52 pregnancies between 1996-2000. To detect the genotypic resistance, the codons for amino acids I-333 of the HIV protease genom and of the viral reverse transcriptase genes were sequenced. Mutations that led at least to a fourfold resistance were assessed as clinically relevant.
RESULTS: Of the 11 different anti-retroviral drug regimens used in this study, 21 were zidovudine-monotherapies, 16 were zidovudine/lamivudine combinations and the rest were several other combination therapies. 31 female patients were naive to therapy at the beginning of pregnancy. 5 of them (i.e. 16%) had primary, relevant resistances. In all, a total of 30 relevant resistances to 10 anti-retroviral drugs occurred during the pregnancy of 14 patients. 6 patients were resistant to the drug with which they had been treated. Just in two cases a change in therapy -dependend on the present resistance- was necessary because of an increase in viral load. Not in one case did a vertical transmission occur.
CONCLUSIONS: Since no vertical transmission occurred, a connection between the presence of a genotypic resistance to anti-retroviral drugs and an increase in vertical transmission could not be proven. Genotypic resistance testing to regulate the medical therapy seemed to be only necessary if a virological failure existed. To what extent the detection of drug resistance of pregnant patients naive to therapy is required, especially in the light of future multiresistant viruses, remains to be clarified in prospective studies.
Copyright © 2000 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.
