Abstract
BackgroundSingle-dose nevirapine (sd-NVP) has been the main option for prevention of mother-to-child transmission (PMTCT) of HIV-1 in low-resource settings. However, sd-NVP can induce the selection of HIV-1 resistant mutations in mothers and infants. In Mozambique, there are limited data regarding the profile of NVP resistance associated mutations (RAM) in the context of PMTCT.ObjectivesTo assess the prevalence and the factors associated with NVP RAM among children born to HIV-1 infected mothers enrolled in the PMTCT programme adopted in Mozambique.MethodsOne hundred and fifty seven children aged 6 to 48 weeks were sequentially included (July 2011 to March 2012) at four centres in Maputo. Genotyping of RAM was performed in samples with HIV-1 RNA≥ 100 copies/μL (Viroseq). Sequencing was performed with ABI 3100 (Applied Biosystems). Logistic regression modelling was undertaken to identify the factors associated with NVP RAM.ResultsSeventy-nine children had their samples genotyped. Their median age was 7.0 (3–12) months and 92.4% received prophylaxis with sd-NVP at birth plus daily NVP. 35.4% of mothers received antiretrovirals (ARVs) for PMTCT. ARV RAM were detected in 43 (54.4%) of the children. 45.6% of these children had at least one NVP RAM. The most common mutations associated with NVP resistance were K103N (n = 16) and Y181C (n = 15). NVP RAM was significantly associated with mother exposure to PMTCT (crude odds ratio [OR] 30.3, 95% CI 4.93–186.34) and with mother’s CD4 count < 350 cells/mm3 (crude OR 3.08, 95% CI 1.02–9.32). In the multivariable analysis the mother’s exposure to PMTCT was the only variable significantly associated with NVP RAM (adjusted OR 48.65, 95% CI 9.33–253.66).ConclusionsWe found a high prevalence of NVP RAM among children who were exposed to the drug regimen for PMTCT in Mozambique. The mothers’ exposure to PMTCT significantly increased the risk of NVP RAM.
Highlights
In 2010, an estimated 390 000 children were newly infected with HIV, primarily due to mother-to-child transmission (MTCT) [1]
NVP resistance associated mutations (RAM) was significantly associated with mother exposure to prevention of MTCT (PMTCT) and with mother’s CD4 count < 350 cells/mm3
In the multivariable analysis the mother’s exposure to PMTCT was the only variable significantly associated with NVP RAM
Summary
In 2010, an estimated 390 000 children were newly infected with HIV, primarily due to mother-to-child transmission (MTCT) [1]. In limited-resource settings, where full access to ART has not been achieved, MTCT rates remain relatively high [4]. Two of the strategic goals of ‘The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive’ are to achieve an ART coverage among pregnant women of 90% and to reduce MTCT to rates < 5%, in low- or mediumincome countries with high estimated prevalence of pregnant women living with HIV [5]. Single-dose nevirapine (sd-NVP) has been the main option for prevention of mother-to-child transmission (PMTCT) of HIV-1 in low-resource settings. In Mozambique, there are limited data regarding the profile of NVP resistance associated mutations (RAM) in the context of PMTCT
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