Maternal Human Immunodeficiency Virus (HIV) Drug Resistance Is Associated With Vertical Transmission and Is Prevalent in Infected Infants. (1st September 2021)

• Record Type: Journal Article
• Authors: Boyce, Ceejay L; Sils, Tatiana; Ko, Daisy; Wong-on-Wing, Annie; Beck, Ingrid A; Styrchak, Sheila M; DeMarrais, Patricia; Tierney, Camlin; Stranix-Chibanda, Lynda; Flynn, Patricia M; Taha, Taha E; Owor, Maxensia; Fowler, Mary Glenn; Frenkel, Lisa M
• Is Part Of: Clinical infectious diseases. Volume 74:Number 11(2022)
• Page Start: 2001
• Page End: 2009
• Publication Date: 2021-09-01
• Subjects: HIV -- drug resistance -- vertical transmission -- prophylaxis -- nevirapine; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciab744
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: 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. Abstract : In this case-control study, maternal human immunodeficiency virus (HIV) drug resistance to non-nucleoside reverse transcriptase inhibitors was an independent risk factor for vertical transmission during breastfeeding, suggesting that nevirapine prophylaxis of infants may provide insufficient protection against drug-resistant variants in breast milk.