The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study

Publication

The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study

Journal Paper/Review - Apr 4, 2019

Compagno Francesca, Hirsch Hans H, Rudin Christoph, Battegay Manuel, Böni Jürg, Yerly Sabine, Paioni Paolo, Martinez de Tejada Begoña, Aebi-Popp Karoline, Hösli Irène, Kahlert Christian, Naegele Klaudia, Swiss HIV Cohort Study

Citation

Compagno F, Hirsch H, Rudin C, Battegay M, Böni J, Yerly S, Paioni P, Martinez de Tejada B, Aebi-Popp K, Hösli I, Kahlert C, Naegele K, Swiss HIV Cohort Study. The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study. Swiss Med Wkly 2019; 149:w20059.

Type

Journal Paper/Review (English)

Journal

Swiss Med Wkly 2019; 149

Publication Date

Apr 4, 2019

Issn Electronic

1424-3997

Pages

w20059

Brief description/objective

AIMS OF THE STUDY
Combination antiretroviral therapy (cART) has reduced mother-to-child transmissions (MTCT) and improved the prognosis of HIV-infected newborns. However, drug resistance mutations (DRM) in HIV-infected children, either transmitted by MTCT (HIV-tDRM) or selected by suboptimal adherence and drug levels (HIV-sDRM), remain a concern. We sought to determine the rate of HIV-tDRM and HIV-sDRM in MTCT pairs in Switzerland.

METHODS
We performed a retrospective analysis of prospectively collected clinical data and available stored samples from MTCT pairs participating in the Swiss Mother-Child HIV (MoCHIV) cohort.

RESULTS
We identified 22 HIV-infected mother-child pairs with delivery between 1989 and 2009 who had 15 years of follow-up (33% white ethnicity). Twenty-one women (96%) were treatment-naïve before pregnancy, 8 (36%) had an unknown HIV status and delivered vaginally, 2 were diagnosed but not treated, and 11 (50%) received antiretrovirals during pregnancy or at delivery, of whom only 6 cases (27%) had cART. HIV subtypes were concordant in all mother-child pairs (subtype B 13/22 [59%]). Using stored plasma (n = 66) and mononuclear cell (n = 43) samples from the children, HIV-tDRM (M184V) was identified in 1 of 22 (4.5%) mothers (1/11 treated, 9%) and was followed by HIV-sDRM at 10 months of age. HIV-sDRM (M184V 23%; K103N 4.5%; D67N 13.6%) occurred in 16/22 (73%) after 4 years, half of whom were treatment naïve. HIV-sDRM were associated with a lower CD4 T-cell nadir (p <0.05) and tended to have higher viral loads and more frequent cART changes.

CONCLUSIONS
HIV-tDRM were low in this Swiss MoCHIV cohort, making them a minor yet preventable complication of prenatal HIV care, whereas HIV-sDRM are a significant challenge in paediatric HIV care.