HIV-1 infection and pregnancy in young women in Brazil: socioeconomic and drug resistance profiles in a cross-sectional study.

Objectives: To describe socioeconomic and antiretroviral ( ARV) drug resistance profiles among young pregnant women infected with HIV-1. Setting: A public health antenatal programme responsible for screening similar to 90 000 pregnant women per year for nine different infectious diseases in Central Western Brazil. Participants: 96 young pregnant women ( 15-24 years) infected with HIV-1. Primary and secondary outcome measures: Standard interviews and blood samples were taken at the time of recruitment, at the first medical appointment after confirmation of diagnosis of HIV-1 infection, and before ARV prophylaxis initiation. Clinical and laboratory data were retrieved from medical files. HIV-1 pol gene sequences ( entire protease/PR, partial reverse transcriptase/RT) were obtained from plasma RNA. ARV resistance mutations ( CPR/Stanford HIV-1; International AIDS Society-USA databases) were identified. Results: The median age was 21 years; most reported <8 years education; 73% were recently diagnosed. Approximately 20% ( 19/96) presented late for antenatal care ( after 26 gestational weeks), while 49% reported >= 2 previous pregnancies. Possible heterosexual transmission by an HIV-1 infected partner ( 17%) and commercial sex work ( 2%) were reported. The median of CD4 cell count was 526 cells/mm(3); the median viral load was: 10 056 copies/mL in ARV-naive ( 48/96) patients and 5881 copies/mL in ARV-exposed ( 48/96) patients. Two probable seroconversion cases during pregnancy were identified in adolescents. One mother-to-child transmission case ( 1.0%) was observed. Transmitted drug resistance among ARV-naive patients was 9.3% ( CI 95% 3.3% to 19.6%); secondary drug resistance among ARV-exposed patients was 12.5% ( CI 95% 4.7% to 25.6%). Conclusions: Despite high access to antenatal care, the low socioeconomic-educational profiles seen in these young HIV-1-infected women highlight the necessity of improved public health educational and preventive strategies regarding HIV infection and early unplanned pregnancy.