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Low emergence of drug resistance after HAART interruption at delivery in a cohort of HIV+ pregnant women in Rio de Janeiro, Brazil
Presented by Jose Henrique Pilotto, Brazil.
J.H. Pilotto1, B. Grinsztejn1, V.G. Veloso1, J.-C. Couto-Fernandez2, A. Rodrigues-Pedro2, J.E. Ribeiro1, E. Lima3, R. Khalili1, S. Muri3, R. Ismerio2, J. Currier4, M.G. Morgado2
1Fundação Oswaldo Cruz - FIOCRUZ, Instituto de Pesquisa Clínica Evandro Chagas - IPEC, Rio de Janeiro, Brazil, 2Fundação Oswaldo Cruz - FIOCRUZ, Instituto Oswaldo Cruz - IOC, Rio de Janeiro, Brazil, 3Hospital Geral de Nova Iguaçu - HGNI, DST, Nova Iguaçu, RJ., Brazil, 4Univ. of California, Care Ctr., Los Angeles, United States
Background: Brazilian guidelines stipulate that HIV+ pregnant women initiating HAART for PMTCT, who do not otherwise need ARV for their own health, discontinue ART after delivery. However, it is unknown how frequent drug resistance is with this strategy. The objectives are to evaluate the impact of antiretroviral discontinuation following delivery for the emergence of genotypic resistance.
Methods: Since January 2005, an HIV+ pregnant women cohort has been established at Hospital Geral de Nova Iguaçu. HAART for PMTCT was used according to the Brazilian Guidelines. Clinical/lab evaluations (CD4, HIV-RNA and genotyping were performed at baseline, 6-8 weeks after HAART, delivery and postpartum [15days, 1, 6 and 12 months]).
Results: 210 women/babies have been enrolled and followed. Data from the first 157 ARV naïve pregnant women who delivered are presented. Median age is 26 years; 72% women are non-white, median gestational age at prenatal care initiation is 26 weeks. Median CD4 cell count at baseline is 439.5 cells/mm3 and VL 3.91 log10. 25% received a Nevirapine-based and 75% a Nelfinavir based regimen. The median time on ART was 75 days. The median VL reduction following initiation of ART was 2.01 log10 copies/ml. 89.5% had <1,000 copies/ml at delivery. HIV primary drug resistant analysis showed NRTI resistance in 8,2%, PI resistance in 3%, NNRTI resistance in 2,25%. Fifty women had samples amplified two weeks post-delivery. M184V was detected in 6% and K103N/Y181C in 2%. These women had no mutation at baseline.
Eighty women had samples amplified four weeks after delivery. M184V was detected in 2,5%, V106A in 1,25%, and K103N in 2,5% of the patients. These women had no mutation at baseline.
Conclusions: No cases of MTCT of HIV have occurred. Most patients achieved HIV RNA Viral Load <1.000 copies/mL at delivery. Low levels of drug resistance have been detected at baseline and after ARV discontinuation so far.
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