High rates of baseline antiretroviral resistance among HIV-infected pregnant women in an HIV referral centre in Rio de Janeiro, Brazil.

Autor:	de Lourdes Teixeira M; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil Laboratory of Epidemiology Research and Social Determinants of Health, Instituto Nacional de Infectologia Evandro Chagas INI/IPEC-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Nafea S; David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA., Yeganeh N; David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA., Santos E; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Gouvea MI; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil Laboratory of Epidemiology Research and Social Determinants of Health, Instituto Nacional de Infectologia Evandro Chagas INI/IPEC-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil., Joao E; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Ceci L; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Bressan C; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Cruz ML; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Sidi LC; Department of Infectious Diseases, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil., Nielsen-Saines K; David Geffen School of Medicine at UCLA, Department of Pediatrics, Division of Infectious Diseases, University of California, Los Angeles, CA, USA knielsen@mednet.ucla.edu.
Jazyk:	angličtina
Zdroj:	International journal of STD & AIDS [Int J STD AIDS] 2015 Nov; Vol. 26 (13), pp. 922-8. Date of Electronic Publication: 2014 Dec 09.
DOI:	10.1177/0956462414562477
Abstrakt:	In order to understand antiretroviral resistance during pregnancy and its impact on HIV vertical transmission, we performed a cross-sectional analysis of 231 HIV-infected pregnant women who fulfilled Brazilian guidelines for antiretroviral testing and had antiretroviral genotypic testing performed between April 2010 and October 2012. At entry into prenatal care, the mean CD4 cell count for this cohort of patients was 406 cells/mm(3) (95% CI: 373-438 cells/mm(3)), while the mean HIV RNA was 24,394 copies/ml (95% CI: 18,275-30,513 copies/ml). Thirty-six women (16%) had detectable antiretroviral-resistant mutations. By 34 weeks gestation, 75% had achieved HIV RNA <400 copies/ml. Our logistic regression model showed the odds of harbouring antiretroviral-resistant virus with a baseline CD4 cell count of <200 cells/mm(3) was eight times that of subjects with CD4 cell counts >500 CD4 cells/mm(3) (95% CI 1.5-42.73). Six infants were HIV infected, four born to mothers with detectable viraemia at 34 weeks and two born to mothers who were lost to follow up. Antiretroviral resistance is common in prenatal care but did not increase vertical transmission if viral load was appropriately suppressed. Genotyping should be considered in Brazil in order to assist initiation of appropriate combination antiretroviral therapy during pregnancy to suppress viral load to avoid vertical transmission. (© The Author(s) 2015.)
Databáze:	MEDLINE
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