The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study

Francesca Compagno; Klaudia Naegele; Christian R. Kahlert; Irene Hösli; Karoline Aebi-Popp; Begona Martinez de Tejada; Paolo Paioni; Sabine Yerly; Jürg Böni; Manuel Battegay; Christoph Rudin; Hans H. Hirsch; the Swiss HIV Cohort Study

doi:10.4414/smw.2019.20059

Swiss Medical Weekly (Apr 2019)

The rate of mother-to-child transmission of antiretroviral drug-resistant HIV strains is low in the Swiss Mother and Child HIV Cohort Study

Francesca Compagno,
Klaudia Naegele,
Christian R. Kahlert,
Irene Hösli,
Karoline Aebi-Popp,
Begona Martinez de Tejada,
Paolo Paioni,
Sabine Yerly,
Jürg Böni,
Manuel Battegay,
Christoph Rudin,
Hans H. Hirsch,
the Swiss HIV Cohort Study

Affiliations

Francesca Compagno: Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland
Klaudia Naegele: Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland; Clinical Virology, Laboratory Medicine, University Hospital Basel, Switzerland
Christian R. Kahlert: Children’s Hospital of Eastern Switzerland and Cantonal Hospital, St Gallen, Switzerland
Irene Hösli: University Women`s Hospital Basel, Switzerland
Karoline Aebi-Popp: Department of Infectious Diseases, Bern University Hospital, Switzerland
Begona Martinez de Tejada: Department of Obstetrics and Gynaecology, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
Paolo Paioni: University Children's Hospital Zurich, Switzerland
Sabine Yerly: Laboratory of Virology, University Hospital Geneva, Switzerland
Jürg Böni: Institute of Medical Virology, University of Zurich, Switzerland
Manuel Battegay: Infectious Diseases and Hospital Epidemiology, University Hospital Basel, and University of Basel, Switzerland
Christoph Rudin: University Children’s Hospital, Basel, Switzerland
Hans H. Hirsch: Transplantation and Clinical Virology, Department of Biomedicine, University of Basel, Switzerland; Clinical Virology, Laboratory Medicine, University Hospital Basel, Switzerland; Infectious Diseases and Hospital Epidemiology, University Hospital Basel, and University of Basel, Switzerland
the Swiss HIV Cohort Study: Members of the Swiss HIV Cohort Study and the Swiss Mother and Child HIV Cohort Study: Aebi-Popp K, Anagnostopoulos A, Asner S, Battegay M, Baumann M, Bernasconi E, Böni J, Braun DL, Bucher HC, Calmy A, Cavassini M, Ciuffi A, Duppenthaler A, Dollenmaier G, Egger M, Elzi L, Fehr J, Fellay J, Francini K, Furrer H, Fux CA, Grawe C, Günthard HF (President of the SHCS), Haerry D (deputy of "Positive Council"), Hasse B, Hirsch HH, Hoffmann M, Hösli I, Huber M, Kahlert CR (Chairman of the Mother & Child Substudy), Kaiser L, Keiser O, Klimkait T, Kottanattu L, Kouyos RD, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Marzolini C, Metzner KJ, Müller N, Nicca D, Paioni P, Pantaleo G, Perreau M, Polli Ch, Rauch A (Chairman of the Scientific Board), Rudin C, Scherrer AU (Head of Data Centre), Schmid P, Speck R, Stöckle M (Chairman of the Clinical and Laboratory Committee), Tarr P, Thanh Lecompte M, Trkola A, Vernazza P, Wagner N, Wandeler G, Weber R, Wyler CA, Yerly S.

DOI: https://doi.org/10.4414/smw.2019.20059
Journal volume & issue: Vol. 149, no. 1314

Abstract

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AIMS OF THE STUDY Combination antiretroviral therapy (cART) has reduced mother-to-child transmissions (MTCT) and improved the prognosis of HIV-infected newborns. However, drug resistance mutations (DRM) in HIV-infected children, either transmitted by MTCT (HIV-tDRM) or selected by suboptimal adherence and drug levels (HIV-sDRM), remain a concern. We sought to determine the rate of HIV-tDRM and HIV-sDRM in MTCT pairs in Switzerland. METHODS We performed a retrospective analysis of prospectively collected clinical data and available stored samples from MTCT pairs participating in the Swiss Mother-Child HIV (MoCHIV) cohort. RESULTS We identified 22 HIV-infected mother-child pairs with delivery between 1989 and 2009 who had 15 years of follow-up (33% white ethnicity). Twenty-one women (96%) were treatment-naïve before pregnancy, 8 (36%) had an unknown HIV status and delivered vaginally, 2 were diagnosed but not treated, and 11 (50%) received antiretrovirals during pregnancy or at delivery, of whom only 6 cases (27%) had cART. HIV subtypes were concordant in all mother-child pairs (subtype B 13/22 [59%]). Using stored plasma (n = 66) and mononuclear cell (n = 43) samples from the children, HIV-tDRM (M184V) was identified in 1 of 22 (4.5%) mothers (1/11 treated, 9%) and was followed by HIV-sDRM at 10 months of age. HIV-sDRM (M184V 23%; K103N 4.5%; D67N 13.6%) occurred in 16/22 (73%) after 4 years, half of whom were treatment naïve. HIV-sDRM were associated with a lower CD4 T-cell nadir (p <0.05) and tended to have higher viral loads and more frequent cART changes. CONCLUSIONS HIV-tDRM were low in this Swiss MoCHIV cohort, making them a minor yet preventable complication of prenatal HIV care, whereas HIV-sDRM are a significant challenge in paediatric HIV care.

Published in Swiss Medical Weekly

ISSN: 1424-7860 (Print); 1424-3997 (Online)
Publisher: SMW supporting association (Trägerverein Swiss Medical Weekly SMW)
Country of publisher: Switzerland
LCC subjects: Medicine
Website: http://www.smw.ch

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