Mother-to-Child Transmission of Drug Resistant HIV-1 in Selected PMTCT Clinics in Rwanda
DOI:
https://doi.org/10.47672/ajhmn.2795Keywords:
PMTCT-clinics, HIV-1, Reverse transcriptase, transmitted and acquired Drug resistanceAbstract
Purpose: This study aims at determining the prevalence of high and low frequency HIV drug resistance mutations and determine the HIV-1 genetic diversity distributions with aim of generating new findings, in the era of option B and B+, towards informed decision-making for more efficient ART strategies and therapeutic monitoring in the PMTCT-Clinics in Rwanda, it is then crucial to set-up bold and innovative approaches in the pediatric AIDS response tailored to the specific needs of the local HIV epidemic.
Materials and Methods: Mother-baby baseline viral load was performed on plasma samples and/or Dried Blood Spots(DBS) using the COBAS® AmpliPrep/ COBAS® TaqMan® HIV-1 Test, v2.0 on a COBAS® AmpliPrep Instrument (Roche Molecular Systems) and Early Infant Diagnosis was by HIV DNA PCR using the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Qualitative Test v2.0. While the HIV drug resistance was analyzed using HIV Genome Pro Software from MGI Tech, which was also used to identify HIV subtypes based on phylogenetic analysis.
Findings: Study revealed that the HIV drug resistance mutations detected or observed constituted 9 out of 32(28%) mother-baby pairs with at least one of HIV drug resistance mutations observed. While 23 out of 32(72%) of mother-baby pairs had no HIVDRMs detected or observed. M184V mutations were observed in mothers by 25% and babies by 30%, with 83% being transmitted to their babies. While K103N, mutations were found in mothers by 22% and 19% among their babies, with 100% being transmitted to their babies. It was also observed that the HIV-1 subtype A/A1 were predominant with 26% being reported among the identified subtypes in mother-baby pairs.
Unique Contribution to Theory, Practice and Policy: The findings emphasize the importance of starting antiretroviral therapy (ART) early ideally before conception and maintaining consistent viral suppression throughout pregnancy and breastfeeding to minimize the risk of mother-to-child HIV transmission. They also highlight the need for regular monitoring of drug resistance and viral subtypes among both mothers and infants to guide effective treatment choices and prevent the spread of resistant strains. Strengthening postpartum follow-up systems is equally critical, including supporting maternal adherence, ensuring timely viral load and infant testing, and providing appropriate prophylaxis. Furthermore, the growing diversity of HIV-1 subtypes and the emergence of recombinant forms should be considered when developing regionally tailored ART regimens and vaccine strategies.
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Copyright (c) 2025 Gad Rutayisire, Roman Saba Ntale, Semwaga Emmanuel, Fred Kyeyune, Nsereko Vincent, Uwera Marie Grace, Tumusiime Musafiri, Mike Rurangwa, Innocent Ishami, Enock Wekia, Richard Mulondo, Noah Kiwanuka, Bernard Ssentalo Bagaya
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