Transmission of drug-resistant HIV-1 strains has been gaining attention and is becoming a growing problem throughout the world. The aim of this study was to determine the prevalence of transmitted drug resistance mutations (TDRM) among antiretroviral (ARV)-naive HIV-infected pregnant women in Rio de Janeiro, Brazil. ARV-naive pregnant women were recruited at Hospital Geral de Nova Iguacu (HGNI), Rio de Janeiro, from 2005 to 2008. HIV genotyping was carried out using ViroSeq (Abbott v. 2.0). TDRM were detected using the Calibrated Population Resistance Tool-CPR v. 6.0.The prevalence of mutations associated with resistance in the protease and reverse transcriptase regions of the HIV genome were assessed in samples collected prior to initiation of ARV prophylaxis or treatment. Among 238 eligible specimens that were collected, 197 samples were successfully amplified using reverse transcription polymerase chain reaction. Eighty-one percent of women were infected with HIV subtype B, 10% with subtype F1 viruses, 1.0% with subtype C virus, and 8.0% with recombinant forms of the virus. The prevalence of HIV TDRM was 5.6% for nucleoside reverse transcriptase inhibitors, 2.0% for nonnucleoside reverse transcriptase inhibitors, and 3.0% for protease inhibitors. The overall prevalence of any drug resistance was 10.7%. There were no multiclass resistant strains identified in the analyzed samples. The prevalence of HIV TDRM among the pregnant women in our cohort was moderate. Resistance testing should be encouraged in Rio de Janeiro, among other locations, for all HIV-infected pregnant women prior to prevention of mother-to-child transmission of HIV.
Get full access to this article
View all access options for this article.
References
1.
MS. Recomendações para terapia anti-retroviral em adultos infectados pelo HIV 2007/2008; Comitê assesor em terapia anti-retroviral para adultos infectados pelo HIV.Secretaria de Vigilância em Saúde. Brasil: Ministério da Saúde, Brasil, 2008.
2.
MarinsJR, JamalLF, ChenSYet al.Dramatic improvement in survival among adult Brazilian AIDS patients. AIDS, 2003; 17,(11):1675–1682.
3.
GrinsztejnB, VelosoVG, PilottoJH, CamposDP, KerulyJC, MooreRD. Comparison of clinical response to initial highly active antiretroviral therapy in the patients in clinical care in the United States and Brazil. J Acquir Immune Defic Syndr, 2007; 45,5:515–520.
4.
CamposDP, RibeiroSR, GrinsztejnBet al.Survival of AIDS patients using two case definitions, Rio de Janeiro, Brazil, 1986–2003. AIDS, 2005; 19,Suppl 4:S22–26.
5.
BrigidoL, RodriguesR, CassebJet al.CD4+ T-cell recovery and clinical outcome in HIV-1-infected patients exposed to multiple antiretroviral regimens: Partial control of viremia is associated with favorable outcome. AIDS Patient Care STDS, 2004; 18,4:189–198.
6.
BrindeiroRM, DiazRS, SabinoECet al.Brazilian Network for HIV Drug Resistance Surveillance (HIV-BResNet): A survey of chronically infected individuals. AIDS, 2003; 17,7:1063–1069.
7.
GerettiAM. New horizons in antiretroviral drug resistance. J HIV Ther, 2007; 12,4:81–82.
8.
ShetA, BerryL, MohriHet al.Tracking the prevalence of transmitted antiretroviral drug-resistant HIV-1: A decade of experience. J Acquir Immune Defic Syndr, 2006; 41,4:439–446.
9.
PalmaAC, AraujoF, DuqueV, BorgesF, PaixaoMT, CamachoR. Molecular epidemiology and prevalence of drug resistance-associated mutations in newly diagnosed HIV-1 patients in Portugal. Infect Genet Evol, 2007; 7,3:391–398.
10.
BoothCL, GerettiAM. Prevalence and determinants of transmitted antiretroviral drug resistance in HIV-1 infection. J Antimicrob Chemother, 2007; 59,6:1047–1056.
11.
GiffordRJ, LiuTF, RheeSYet al.The calibrated population resistance tool: Standardized genotypic estimation of transmitted HIV-1 drug resistance. Bioinformatics, 2009; 25,9:1197–1198.
LoleKS, BollingerRC, ParanjapeRSet al.Full-length human immunodeficiency virus type 1 genomes from subtype C-infected seroconverters in India, with evidence of intersubtype recombination. J Virol, 1999; 73,1:152–160.
14.
CoovadiaH. Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS. N Engl J Med, 2004; 351,3:289–292.
15.
WellesSL, BauerGR, LaRussaPS, ColgroveRC, PittJ. Time trends for HIV-1 antiretroviral resistance among antiretroviral-experienced and naive pregnant women in New York City during 1991 to early 2001. J Acquir Immune Defic Syndr, 2007; 44,3:329–335.
16.
SchackmanBR, RibaudoHJ, KrambrinkA, HughesV, KuritzkesDR, GulickRM. Racial differences in virologic failure associated with adherence and quality of life on efavirenz-containing regimens for initial HIV therapy: Results of ACTG A5095. J Acquir Immune Defic Syndr, 2007; 46,5:547–554.
17.
ParaskevisD, MagiorkinisE, KatsoulidouAet al.Prevalence of resistance-associated mutations in newly diagnosed HIV-1 patients in Greece. Virus Res, 2005; 112,1–2:115–122.
18.
WensingAM, van de VijverDA, AngaranoGet al.Prevalence of drug-resistant HIV-1 variants in untreated individuals in Europe: Implications for clinical management. J Infect Dis, 2005; 192,6:958–966.
19.
LamaJR, SanchezJ, SuarezLet al.Linking HIV and antiretroviral drug resistance surveillance in Peru: A model for a third-generation HIV sentinel surveillance. J Acquir Immune Defic Syndr, 2006; 42,4:501–505.
20.
SPREAD: Transmission of drug-resistant HIV-1 in Europe remains limited to single classes. SPREAD Programme. AIDS, 2008; 22,5:625–635.
21.
VercauterenJ, DerdelinckxI, SasseAet al.Prevalence and epidemiology of HIV type 1 drug resistance among newly diagnosed therapy-naive patients in Belgium from 2003 to 2006. AIDS Res Hum Retroviruses, 2008; 24,3:355–362.
22.
VandammeAM, SonnerborgA, Ait-KhaledMet al.Updated European recommendations for the clinical use of HIV drug resistance testing. Antivir Ther, 2004; 9,6:829–848.
23.
DHHS: Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. DHHS, U.S. Department of Health and Human Services, 2010; 1–117.
24.
DHHS: Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services, 2011January10, 2011; 1–116.
25.
de RuiterA, MerceyD, AndersonJet al.British HIV Association and Children's HIV Association guidelines for the management of HIV infection in pregnant women 2008. HIV Med, 2008; 9,7:452–502.
26.
GazzardBG, AndersonJ, BabikerAet al.British HIV Association Guidelines for the treatment of HIV-1-infected adults with antiretroviral therapy 2008. HIV Med, 2008; 9,8:563–608.
27.
SaxPE, IslamR, WalenskyRPet al.Should resistance testing be performed for treatment-naive HIV-infected patients? A cost-effectiveness analysis. Clin Infect Dis, 2005; 41,9:1316–1323.
28.
CardosoLP, PereiraGA, ViegasAA, SchmaltzLE, StefaniMM. HIV-1 primary and secondary antiretroviral drug resistance and genetic diversity among pregnant women from central Brazil. J Med Virol, 2010; 82,3:351–357.
29.
AlcantaraKC, LinsJB, AlbuquerqueMet al.HIV-1 mother-to-child transmission and drug resistance among Brazilian pregnant women with high access to diagnosis and prophylactic measures. J Clin Virol, 2012; 54,1:15–20.
30.
GonsalezCR, AlcaldeR, NishiyaAet al.Drug resistance among chronic HIV-1-infected patients naive for use of anti-retroviral therapy in Sao Paulo city. Virus Res, 2007; 129,2:87–90.
31.
InocencioLA, PereiraAA, SucupiraMCet al.Brazilian Network for HIV Drug Resistance Surveillance: A survey of individuals recently diagnosed with HIV. J Int AIDS Soc, 2009; 12,1:20.
32.
SprinzE, NettoEM, PatelliMet al.Primary antiretroviral drug resistance among HIV type 1-infected individuals in Brazil. AIDS Res Hum Retroviruses, 2009; 25,9:861–867.
33.
FerreiraAS, CardosoLP, StefaniMM. Moderate prevalence of transmitted drug resistance and high HIV-1 genetic diversity in patients from Mato Grosso State, Central Western Brazil. J Med Virol, 2011; 83,8:1301–1307.
34.
DumansAT, SoaresMA, PieniazekDet al.Prevalence of protease and reverse transcriptase drug resistance mutations over time in drug-naive human immunodeficiency virus type 1-positive individuals in Rio de Janeiro, Brazil. Antimicrob Agents Chemother, 2002; 46,9:3075–3079.
35.
SucupiraMC, CaseiroMM, AlvesKet al.High levels of primary antiretroviral resistance genotypic mutations and B/F recombinants in Santos, Brazil. AIDS Patient Care STDS, 2007; 21,2:116–128.
36.
DuranAS, LossoMH, SalomonHet al.Drug resistance among HIV-infected pregnant women receiving antiretrovirals for prophylaxis. AIDS, 2007; 21,2:199–205.
37.
VianiRM, HsiaK, HubbardPet al.Prevalence of primary HIV-1 drug resistance in pregnant women and in newly diagnosed adults at Tijuana General Hospital, Baja California, Mexico. Int J STD AIDS, 2007; 18,4:235–238.
38.
NyombiBM, Holm-HansenC, KristiansenKI, BjuneG, MullerF. Prevalence of reverse transcriptase and protease mutations associated with antiretroviral drug resistance among drug-naive HIV-1 infected pregnant women in Kagera and Kilimanjaro regions, Tanzania. AIDS Res Ther, 2008; 5:13.
39.
CastelbrancoEP, da Silva SouzaE, CavalcantiAM, MartinsAN, de AlencarLC, TanuriA. Frequency of primary resistance to antiretroviral drugs and genetic variability of HIV-1 among infected pregnant women recently diagnosed in Luanda-Angola. AIDS Res Hum Retroviruses, 2010; 26,12:1313–1316.
40.
AjogeHO, GordonML, IbrahimS, ShittuOS, Ndung'uT, OlonitolaSO. Drug resistance pattern of HIV type 1 isolates sampled in 2007 from therapy-naive pregnant women in North-Central Nigeria. AIDS Res Hum Retroviruses, 2012; 28,1:115–118.
41.
HechtFM, GrantRM. Resistance testing in drug-naive HIV-infected patients: Is it time?Clin Infect Dis, 2005; 41,9:1324–1325.
42.
Garcia-LermaJG, HeneineW. Resistance of human immunodeficiency virus type 1 to reverse transcriptase and protease inhibitors: Genotypic and phenotypic testing. J Clin Virol, 2001; 21,3:197–212.
43.
GhosnJ, PellegrinI, GoujardCet al.HIV-1 resistant strains acquired at the time of primary infection massively fuel the cellular reservoir and persist for lengthy periods of time. AIDS, 2006; 20,2:159–170.
44.
BrennerBG, RogerM, RoutyJPet al.High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis, 2007; 195,7:951–959.
45.
Van LaethemK, VandammeAM. Interpreting resistance data for HIV-1 therapy management—know the limitations. AIDS Rev, 2006; 8,1:37–43.
