Primary resistance to reverse transcriptase inhibitors and protease inhibitors in women of childbearing age and pregnant women with HIV

Abstract

Introduction: Women of childbearing age (WCA) and pregnant women are usually underrepresented in transmitted drug resistance (TDR) surveillance studies for antiretrovirals compared to the male population. Our objective was to evaluate TDR in this population.

Materials and Methods: We conducted a retrospective analysis of a TDR database from two HIV reference centers in Argentina (2016–2022). The samples correspond to baseline genotypes requested as part of standard care. WCA were defined as those between 15 and 49 years old. Resistance-associated mutations (RAMs) to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), and protease inhibitors (PIs) were identified using the WHO mutation list.

Results: We included 259 WCA: 202 non-pregnant WCA and 57 pregnant women. The median (interquartile range) age was 36 (30–41) years. Overall TDR increased over the years (p = 0.034), mainly due to resistance to PIs (2016/17: 2.7% vs. 2021/22: 18%, p = 0.002). In non-pregnant WCA, the prevalence of RAMs was 15% (mostly to NNRTIs). The most frequent RAMs were K103N (10.5%), K103S, Y181V, M41L (2% each), and M46L, I54V, and V82A (2.1% each). Among pregnant women, 11% (n = 6) presented RAMs, all corresponding to NNRTIs.

Conclusions: Our results suggest that the levels of transmitted resistance in this population remain at moderate levels, mainly driven by RAMs to NNRTIs.