Characterizing HIV Drug Resistance in Vertical Transmission Cases
Study Overview
The VESTED trial compared the safety and effectiveness of three different antiretroviral treatment regimens in pregnant and postpartum women with HIV. The study aimed to evaluate the occurrence of vertical HIV transmission (VT) in infants born to these women and to assess HIV drug resistance (HIVDR) and other risk factors in these cases.
Study Methods
Pregnant women with HIV were enrolled at 22 international sites and followed with their infants through 50 weeks postpartum. HIV sequences were analyzed from VT cases for HIVDR using single genome amplification (SGA) from longitudinally collected specimens.
Key Findings
Four cases of VT occurred out of 617 live-born infants, with a VT rate of 0.60%. Major non-nucleoside reverse transcriptase inhibitor (NNRTI) HIVDR mutations were detected in all three surviving infants. No integrase mutations conferring dolutegravir HIVDR were found. The timing of HIV infant diagnosis, plasma HIV RNA levels, and HIVDR suggested various modes of transmission.
Conclusions
VT was rare, and new-onset NNRTI HIVDR in case mothers appeared to be associated with the antiretroviral treatment prescribed. Despite nevirapine prophylaxis, HIVDR was transmitted to one infant. These findings highlight the importance of understanding and addressing HIV drug resistance in the context of vertical transmission.
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