16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

DEVELOPMENT OF ANTIRETROVIRAL RESISTANCE AMONG HIV-1-INFECTED WOMEN FIRST EXPOSED TO ANTIRETROVIRALS DURING PREGNANCY: THE NICHD INTERNATIONAL SITE DEVELOPMENT INITIATIVE (NISDI) PERINATAL STUDY

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. WeAb0103

Duran A.¹, Losso M.¹, Salomón H.², Pampuro S.², Harris R.³, Soto-Ramirez L.⁴, Read J.⁵, NISDI Perinatal Study Group
¹ Hospital J.M.Ramos Mejia, Buenos Aires, Argentina, ² CNRS, Buenos Aires, Argentina, ³ Westat, Rockville, United States, ⁴ Instituto Nacional de la Nutricion Salvador Zubiran, Department of Infectious Diseases, Mexico dc, Mexico, ⁵ NICHD, Bethesda, United States

BACKGROUND: To quantify primary resistance mutations (PRMs) among pregnant women receiving ARVs for prevention of MTCT of HIV-1.

METHODS: Peripheral blood mononuclear cell (PBMC) samples at enrollment and 6 – 12 weeks postpartum were assayed for PRMs among HIV-1-infected women enrolled in a prospective cohort study in Argentina, the Bahamas, Brazil and Mexico. The study population was restricted to women enrolled by March 2005, who were diagnosed with HIV-1 infection during the current pregnancy, received ARVs for perinatal transmission prophylaxis, and were followed through 6 – 12 weeks postpartum.

RESULTS: Of 819 women, 198 met the inclusion criteria (98% CDC Category A, 62% viral load <1000 copies/mL, 53% CD4 count >500 cells/mm³). At enrollment, 155 were ARV-experienced (median duration: 7.1 weeks), 43 ARV-naïve. The most complex ARV regimen during pregnancy was: 2NRTIs + either 1NNRTI or 1PI, 81%; similar proportions (~10%) received 1 or 2 NRTIs. Most (94%) received one (150) or two (35) ARV regimens during pregnancy. At enrollment, amplification could not be accomplished for samples from 122 women (and, at 6 – 12 weeks, for 101), primarily related to very low viral load. PRMs were observed in 16 (14%) of 118 samples amplifiable at either time point: four (enrollment only), seven (6 – 12 weeks postpartum only), five (both time points). At enrollment, 9/76 (12%) had PRMs (3 ARV-naïve). At 6 – 12 weeks postpartum, 12/97 (12%) had PRMs. Occurrence of PRMs was not associated with: viral load, CD4 count at either time point, CDC disease classification, whether ARV-naïve vs. experienced at enrollment, or most complex or number of ARV regimens during pregnancy (p>0.1). The most common mutations were K70R, K103N, M46I, D30N. The rate of MTCT [1.5% (3/198)] was not associated with the occurrence of resistance mutations.

CONCLUSIONS: Among HIV-1-infected mothers from Latin American and Caribbean countries receiving ARVs for prevention of MTCT, PRMs are relatively common.

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2006-08-13
WeAb0103

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