Executive summary of the Consensus Statement on monitoring HIV: pregnancy, birth, and prevention of mother-to-child transmission.

The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. If the serological status is unknown at the time of delivery, or in the immediate postpartum, HIV serology testing has to be performed as soon as possible. In this document, recommendations are made regarding the health of the mother and from the perspective of minimizing mother-to-child transmission.

[Consensus statement on monitoring of HIV: pregnancy, birth, and prevention of mother-to-child transmission]. / Documento de consenso para el seguimiento de la infección por el virus de la inmunodeficiencia humana en relación con la reproducción, el embarazo, el parto y la profilaxis de la transmisión vertical del niño expuesto.

OBJECTIVE: The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. METHODS: We assembled a panel of experts appointed by the Secretariat of the National AIDS Plan (SPNS) and the other participating Scientific Societies, which included internal medicine physicians with expertise in the field of HIV infection, gynecologists, pediatricians and psychologists. Four panel members acted as coordinators. Scientific information was reviewed in publications and conference reports up to November 2012. In keeping with the criteria of the Infectious Diseases Society of America, 2levels of evidence were applied to support the proposed recommendations: the strength of the recommendation according to expert opinion (A, B, C), and the level of empirical evidence (I, II, III). This approach has already been used in previous documents from SPNS. RESULTS AND CONCLUSIONS: The aim of this paper was to review current scientific knowledge, and, accordingly, develop a set of recommendations regarding antiretroviral therapy (ART), regarding the health of the mother, and from the perspective of minimizing mother-to-child transmission (MTCT), also taking into account the rest of the health care of pregnant women with HIV infection. We also discuss and evaluate other strategies to reduce the MTCT (elective Cesarean, child's treatment…), and different aspects of the topic (ARV regimens, their toxicity, monitoring during pregnancy and postpartum, etc.).

[Clinical use of HIV-1 resistance genotyping. Predictive factors of poor virological evolution in salvage treatments]. / Utilización en la práctica clínica de los tests de resistencia genotípica al VIH-1. Factores predictivos de mala evolución virológica en tratamientos de rescate.

OBJECTIVES: To describe the use of genotype resistance testing (GRT) for virological failure in clinical practice, and the long-term clinical and virological evolution in patients for whom it is requested. To identify the predictive factors of virological failure in patients with antiretroviral (ARV) salvage therapy. METHODS: Observational study in HIV-infected patients for whom GRT was requested for virological failure (VF) in the period of 1 October 1999 to 31 December 2001. Logistic regression analysis was used to determine the predictive factors of virological progression. RESULTS: Over the period studied, 196 patients required GRT for VF (15%) among those monitored in specific units. GRT was mainly requested for patients who had been extensively pretreated for a mean of 5 years and with a median of 5 ARV combinations. Half the patients presented 3 or more mutations associated with thymidine analogs (TAMs), mutations associated with non-nucleoside analogs (NNRTIs), and 5 or more mutations associated with protease inhibitors (PIs). In 143 (74%) patients, the RTV regimen was changed on the basis of GRT results. In the intent-to-treat analysis, the percentage of patients with plasma VL < 400 cop/mL at 6, 12 and 18 months was 41%, 29% and 17%, respectively. In the on-treatment analysis, the results were 50%, 48% and 46%, respectively. Mean CD4 lymphocyte increase was 59.74 and 94 cells/mm 3. The variables predicting virological failure (plasma VL > 400 cop/mL) at 12 months were plasma VL > 30,000 cop/mL (OR 6, 1.8-19.5) and accumulation of 3 or more TAMs (OR 4.4, 1.3-15) at the start of ARV salvage therapy. CONCLUSION: Even though in clinical practice GRT is requested for patients with various treatment failures, when ART salvage treatment was started, plasma VL was undetectable and immunological response persisted in 40% of patients followed-up for 18 months. The factors best predicting virological evolution were VL and the number of baseline TAMs.

Utilización en la práctica clínica de los tests de resistencia genotípica al VIH-1. Factores predictivos de mala evolución virológica en tratamientos de rescate / Clinical use of HIV-1 resistance genotyping. Predictive factors of poor virological evolution in salvage treatments

Objetivos. Describir la utilización de los tests de resistencia genotípica (TRG) por fracaso virológico en la práctica clínica y la evolución clínica y virológica a largo plazo de los pacientes en los que se solicitaron. Establecer los factores predictivos de fracaso virológico con tratamientos antirretrovirales (TARV) de rescate. Métodos. Estudio observacional de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) a los que se solicitó TRG por fracaso virológico (FV) en el período comprendido entre el 1/10/1999 y 31/12/2001. Se determinaron los factores predictivos de mala evolución virológica mediante un análisis de regresión logística. Resultados. En el período de estudio, 196 pacientes precisaron TRG por FV (15%) de los seguidos en unas consultas específicas. Los TRG se solicitaron mayoritariamente a pacientes extensamente pretratados, con una media de 5 años y una mediana de cinco combinaciones TARV. La mitad de los pacientes presentaban tres o más mutaciones asociadas a análogos de la timidina (TAM), alguna mutación asociada a análogos no nucleósidos (ANNTI) y cinco o más mutaciones asociadas a inhibidores de proteasas (IP). En 143 (74%) se realizó un cambio de TARV en base al TRG recibido. En el análisis por intención de tratar, el porcentaje de pacientes con carga viral (CV) plasmática 400 cop./ml a los 12 meses, fueron tener una CV > 30.000 cop./ml odds ratio (OR) 6 (1,8-19,5) y haber acumulado tres o más TAM OR 4,4 (1,3-15) al iniciar el TARV de rescate. Conclusión. A pesar de que los TRG se solicitan en la práctica clínica en pacientes en multifracaso, al instaurar TARV de rescate se consiguen mantener la CV plasmática indetectables en el 40% de los pacientes en seguimiento a los 18 meses y con una respuesta inmunológica mantenida. Los factores que mejor predicen la evolución virológica son la CV plasmática y el número de TAMbasales (AU)

Objectives. To describe the use of genotype resistance testing (GRT) for virological failure in clinical practice, and the long-term clinical and virological evolution in patients for whom it is requested. To identify the predictive factors of virological failure in patients with antiretroviral (ARV) salvage therapy. Methods. Observational study in HIV-infected patients for whom GRT was requested for virological failure (VF) in the period of 1 October 1999 to 31 December 2001. Logistic regression analysis was used to determine the predictive factors of virological progression. Results. Over the period studied, 196 patients required GRT for VF (15%) among those monitored in specific units. GRT was mainly requested for patients who had been extensively pretreated for a mean of 5 years and with a median of 5 ARV combinations. Half the patients presented 3 or more mutations associated with thymidine analogs (TAMs), mutations associated with non-nucleoside analogs (NNRTIs), and 5 or more mutations associated with protease inhibitors (PIs). In 143 (74%) patients, the RTV regimen was changed on the basis of GRT results. In the intent-to-treat analysis, the percentage of patients with plasma VL 400 cop/mL) at 12 months were plasma VL > 30,000 cop/mL (OR 6, 1.8-19.5) and accumulation of 3 or more TAMs (OR 4.4, 1.3-15) at the start of ARV salvage therapy. Conclusion. Even though in clinical practice GRT is requested for patients with various treatment failures, when ART salvage treatment was started, plasma VL was undetectable and immunological response persisted in 40% of patients followed-up for 18 months. The factors best predicting virological evolution were VL and the number of baseline TAMs (AU)