Maternal Human Immunodeficiency Virus (HIV) Drug Resistance Is Associated With Vertical Transmission and Is Prevalent in Infected Infants
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
Clinical Infectious Diseases
Abstract
We aimed to assess if maternal human immunodeficiency virus (HIV) drug resistance is associated with an increased
risk of HIV vertical transmission and to describe the dynamics of drug resistance in HIV-infected infants.
Methods. This was a case-control study of PROMISE study participants. “Cases” were mother-infant pairs with HIV vertical
transmission during pregnancy or breastfeeding and “controls” were mother-infant pairs without transmission matched 1:3 by delivery
date and clinical site. Genotypic HIV drug resistance analyses were performed on mothers’ and their infants’ plasma at or near
the time of infant HIV diagnosis. Longitudinal analysis of genotypic resistance was assessed in available specimens from infants,
from diagnosis and beyond, including antiretroviral therapy (ART) initiation and last study visits.
Results. Our analyses included 85 cases and 255 matched controls. Maternal HIV drug resistance, adjusted for plasma HIV RNA load
at infant HIV diagnosis, enrollment CD4 count, and antepartum regimens, was not associated with in utero/peripartum HIV transmission.
In contrast, both maternal plasma HIV RNA load and HIV drug resistance were independent risk factors associated with vertical
transmission during breastfeeding. Furthermore, HIV drug resistance was selected across infected infants during infancy.
Conclusions. Maternal HIV drug resistance and maternal viral load were independent risk factors for vertical transmission
during breastfeeding, suggesting that nevirapine alone may be insufficient infant prophylaxis against drug-resistant variants in maternal
breast milk. These findings support efforts to achieve suppression of HIV replication during pregnancy and suggest that
breastfeeding infants may benefit from prophylaxis with a greater barrier to drug resistance than nevirapine alone.
Description
Keywords
HIV, Drug resistance, Vertical transmission, Prophylaxis, Nevirapine
Citation
Boyce, C. L., Sils, T., Ko, D., Wong-on-Wing, A., Beck, I. A., Styrchak, S. M., ... & Frenkel, L. M. (2021). Maternal Human Immunodeficiency Virus (HIV) Drug Resistance Is Associated With Vertical Transmission and Is Prevalent in Infected Infants. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciab744