Antiretroviral adherence, elevated viral load, and drug resistance mutations in human immunodeficiency virus - infected women initiating treatment in pregnancy: a nested case-control study
López, Giselle Ibette Silva; Cabral, Gabriela Bastos; Cavalcanti, Jaqueline de Souza; Silva, Geovana Rafaela.
Clinical Infectious Diseases
; 19: 1-15, 2019.
Artigo
Português
| SES-SP, SES SP - Instituto Adolfo Lutz, SES-SP, SES SP - Acervo Instituto Adolfo Lutz | ID: biblio-1021231
Background Elevated viral load (VL) early after antiretroviral therapy (ART) initiation appears frequently in pregnant and postpartum women living with human immunodeficiency virus; however the relative contributions of pre-ART drug resistance mutations (DRMs) vs nonadherence in the etiology of elevated VL are unknown. Methods Within a cohort of women initiating ART during pregnancy in Cape Town, South Africa, we compared women with elevated VL after initial suppression (cases, n = 80) incidence-density matched to women who maintained suppression over time (controls, n = 87). Groups were compared on pre-ART DRMs and detection of antiretrovirals in stored plasma. Results The prevalence of pre-ART DRMs was 10% in cases and 5% in controls (adjusted odds ratio [aOR], 1.53 [95% confidence interval {CI}, .45.9]); all mutations were to nonnucleoside reverse transcriptase inhibitors. At the time of elevated VL, 19% of cases had antiretrovirals detected in plasma, compared with 87% of controls who were suppressed at a matched time point (aOR, 131.43 [95% CI, 32.8527.4]). Based on these findings, we estimate that <10% of all elevated VL in the cohort may be attributable to pre-ART DRMs vs >90% attributable to ART nonadherence...
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BR91.2
Localização: BR76.1; P
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