BACKGROUND The emergence of HIV drug resistance poses a significant threat to achieving the goal of elimination of mother-to-child transmission. OBJECTIVES We assessed the extent and patterns of HIV-1 drug resistance mutations (DRMs) within the context of the public sector prevention of mother-to-child transmission (PMTCT) programme in the Eastern Cape, South Africa. STUDY DESIGN We conducted analysis of the Pol sub-genomic sequence of RNA extracted from plasma samples of women with probable virological failure at delivery between January and May 2018 from two large maternity centres in the Eastern Cape using standard protocols. Partial pol gene covering 1030bp were amplified and sequenced according to previously reported protocol. DRMs were determined by submitting the generated partial pol sequences to the Stanford drug resistance database for query on mutations associated with drug resistance in HIV viruses. We examined the correlates of DRMs using bivariate analysis. RESULTS The age of parturient women ranged from 16 to 43 years. The majority of the parturient women were currently on Efavirenz-based regimen (first line ART) (82.5%) and had been on ART for more than 12 months (65.0%). The prevalence of DRMs was 72.5% (n = 58). The CD4 count demonstrated a negative linear association with the DRMs (p = 0.002). The predominant DRMs were K103 N (n = 43; 74.1%), M184 V (n = 28; 48.3%) and K65R (n = 11; 19%). Among the parturient women on EFV-based regimen treatment; 79.1% already had K103 N while nine patients on protease inhibitor-based regimen still harboured K103 N. The majority of the M184 V mutations were observed in parturient women on first line regimen (n = 23; 82.1%). CONCLUSIONS We found a high prevalence of DRMs in women delivering their index babies at high viral loads in the study settings. Drug resistance surveillance using point-of-care reverse transcriptase-PCR strategies for the screening of pregnant women on ART could be a game-changer in the resource-constrained settings.

中文翻译：

---

南非东开普省分娩妇女中抗逆转录病毒疗法的HIV-1耐药性监测：对消除母婴传播的影响。

背景技术HIV抗药性的出现对实现消除母婴传播的目标构成重大威胁。目的我们在南非东开普省公共部门预防母婴传播（PMTCT）计划的背景下，评估了HIV-1耐药性突变（DRM）的程度和模式。研究设计我们使用标准方法对2018年1月至5月间从东开普省的两个大型妇产中心分娩的可能发生病毒学衰竭的妇女血浆样本中提取的RNA的Pol亚基因组序列进行了分析。根据先前报道的方案扩增覆盖1030bp的部分pol基因并测序。通过将生成的部分pol序列提交给斯坦福大学耐药数据库来查询与HIV病毒中与耐药相关的突变，从而确定DRM。我们使用双变量分析研究了DRM的相关性。结果产妇的年龄为16至43岁。目前，大多数产妇都接受基于依夫韦伦的方案（一线抗逆转录病毒疗法）（82.5％），并且接受抗逆转录病毒疗法已经超过12个月（65.0％）。DRM的患病率为72.5％（n = 58）。CD4计数显示与DRM呈负线性关联（p = 0.002）。主要的DRM是K103 N（n = 43; 74.1％），M184 V（n = 28; 48.3％）和K65R（n = 11; 19％）。在接受基于EFV的方案治疗的产妇中；已经有79.1％的人患有K103 N，而9位采用蛋白酶抑制剂治疗方案的患者仍带有K103N。一线方案在产妇中观察到大多数M184 V突变（n = 23； 82.1％）。结论我们在研究中发现，在高病毒载量下分娩婴儿的妇女中，DRM的患病率很高。在资源有限的情况下，使用即时点逆转录酶-PCR策略筛查孕妇的抗药性可能会改变游戏规则。