HIV-1 genotypic zidovudine drug resistance and the risk of maternal-infant transmission in the Women and Infants Transmission Study

被引:67
作者
Welles, SL
Pitt, J
Colgrove, R
McIntosh, K
Chung, PH
Colson, A
Lockman, S
Fowler, MG
Hanson, C
Landesman, S
Moye, J
Rich, KC
Zorrilla, C
Japour, AJ
机构
[1] Univ Minnesota, Sch Publ Hlth, Div Epidemiol, Minneapolis, MN 55454 USA
[2] Columbia Univ Coll Phys & Surg, Dept Pediat, Div Infect Dis, New York, NY 10032 USA
[3] Harvard Univ, Sch Med, Beth Israel Deaconess Med Ctr, Div Infect Dis, Boston, MA USA
[4] Harvard Univ, Sch Med, Childrens Hosp, Div Infect Dis, Boston, MA USA
[5] NIH, Div Aids, Bethesda, MD 20892 USA
[6] Texas Childrens Hosp, Baylor Coll Med, Houston, TX 77030 USA
[7] SUNY, Brooklyn, NY USA
[8] NICHHD, Bethesda, MD 20892 USA
[9] Univ Illinois, Dept Pediat, Chicago, IL USA
[10] Univ Puerto Rico, San Juan, PR 00936 USA
关键词
HIV-1; RT drug-resistant mutations; zidovudine drug-resistance;
D O I
10.1097/00002030-200002180-00008
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objectives: Although the treatment of pregnant women and their infants with zidovudine (ZDV) has been remarkably effective in preventing the perinatal transmission of human HIV-1, many potentially preventable infections still occur. To examine whether the risk of perinatal infection is increased among women who carry ZDV-resistant HIV-1, the role of genotypic ZDV resistance in perinatal transmission was evaluated. Methods: The reverse transcriptase (RT) region of clinical isolates from culture supernatants of 142 HIV-1-infected women enrolled in the Women and Infants Transmission Study (WITS), who had been treated with ZDV during pregnancy was sequenced. Results from genotypic sequencing were linked to demographic, laboratory, and obstetrical databases, and the magnitude of association of having consensus drug-resistant HIV-1 RT mutations with transmission was estimated. Results: Twenty-five per cent (34/142) of maternal isolates had at least one ZDV-associated resistance mutation. A lower CD4 cell percentage and count (P = 0.0001) and higher plasma HIV-1 RNA (P = 0.006) were associated with having any ZDV resistance mutation at delivery. Having any RT resistance mutation [odds ratio (OR): 5.16; 95% confidence interval (CI): 1.40, 18.97; P = 0 0.01], duration of ruptured membranes [OR: 1.13 (1.02, 1.26) per 4 h duration; P = 0.02], and total lymphocyte count [OR: 1.06 (1.01, 1.10) per 50 cells higher revel; P = 0.009] were independently associated with transmission in multivariate analysis.
引用
收藏
页码:263 / 271
页数:9
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