4th International AIDS Society Conference on HIV Pathogenesis and Treatment


Sydney, Australia - July 22 - 25, 2007

DRUG RESISTANCE IN HIV-1 INFECTED PREGNANT WOMEN ENROLLED IN THE NATIONAL PMTCT PROGRAM IN HO CHI MINH CITY (HCMC), VIETNAM

IAS Conf HIV Pathog Treat 2007 Jul 22-25;4th: Abstract No. MOPDB06LB

Truong T.X.L.1, Thanh T.C.1, Ton T.1, Tram L.T.1, Thanh L.C.1, Nghia K.V.1, Nhung V.T.2, Quan T.T.V.2, Ngoc H.T.2, Van N.T.A.2
1Pasteur Institute, HIV/AIDS Laboratory, Ho Chi Minh, Viet Nam, 2Hung Vuong Hospital, Ho Chi Minh, Viet Nam

OBJECTIVES: To determine the baseline resistance to ARV in drug naïve HIV-1 infected pregnant women and to monitor drug resistance mutations with different ARV regimens used for PMTCT.

METHODS: HIV-1 positive naïve to ARV pregnant women from Hung Vuong Hospital were enrolled between 04/2005 and 04/2006. According to the National PMTCT guidelines and to the availability of ARVs in Vietnam, 83 women diagnosed HIV-1 positive at the antenatal visit received AZT+3TC(n=49)or AZT+3TC+NFV (n=34) at 32 weeks of pregnancy. The 80 others,tested HIV-1 positive only at labor received a single dose NVP (n=48)or a sdNVP at delivery plus AZT+3TC during one week after delivery (n=32). RT genes were amplified from plasma collected before ARV exposure, at delivery, 2 and 8 weeks postpartum and directly sequenced.

RESULTS: 163 drug naïve women (mean: age 25 [17-43], CD4 418/mm3[39-1299] were enrolled. HIV-1CRF01-AE was predominant (98.2%). The frequency of drug resistance mutations was low at baseline 0.6% (1 case V75M resist to d4T in a recently infected 20 yr-mother CD4 949/mm3). M184V/I associated 3TC resistance was respectively detected for mothers using AZT+3TC in 45.5% (5/11) at delivery, 32.3 %(10/31) at 2 weeks,none at 8 weeks postpartum (0/39). For mothers using AZT+3TC+NFV, no mutation was detected at delivery (0/8), 2 weeks (0/25) or 8 weeks postpartum (0/19),the difference was statistically significant between 2 groups (p<0.001). NVP resistance was found in women receiving sdNVP at labor: 23.8%(5/21) at 2 weeks and 8.3%(2/24) at 8 weeks postpartum. No NVP resistance was among women using plus 1 week - AZT+3TC 2 weeks(0/18), 8 weeks(0/15) postpartum,the difference was statistically significant (p<0.001). The most common NVP resistance mutations were K103K/N,Y181Y/C,Y188Y/C,G190G/A.

CONCLUSIONS: Low frequency of drug resistance was observed among ARV naïve mothers, probably related to recently access ARVs in Vietnam. 3TC and NVP mutations were detected in mothers used AZT+3TC or sdNVP respectively,except 3 drugs were used either during pregnancy or in short term regimen,strengthening recommendations for combining ARVs in PMTCT.

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2007-07-22
MOPDB06LB
Pathogenesis and Treatment in Women

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