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

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

abstract

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.
   
citation Compagno F, Naegele K, Kahlert C R, Hösli I, Aebi-Popp K, Martinez de Tejada B, Paioni P, Yerly S, Böni J, Battegay M, Rudin C, Hirsch H H, 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)
date of publishing 04-04-2019
journal title Swiss Med Wkly (149)
ISSN electronic 1424-3997
pages w20059
PubMed 30946481
DOI 10.4414/smw.2019.20059