Glob Health Action. 2015 Jan 27;8:26065. – http://dx.doi.org/10.3402/gha.v8.26065
Prevention of mother-to-child HIV-1 transmission in Burkina Faso: evaluation of vertical transmission by PCR, molecular characterization of subtypes and determination of antiretroviral drugs resistance
Tani Sagna1,2*, Cyrille Bisseye1,3, Tegewende R. Compaore1,4, Therese S. Kagone1, Florencia W. Djigma1, Djeneba Ouermi1,4, Catherine M. Pirkle5, Moctar T. A. Zeba1, Valerie J. T. Bazie1, Zoenabo Douamba1, Remy Moret1, Virginio Pietra4, Adjirita Koama1, Charlemagne Gnoula1, Joseph D. Sia4, Jean-Baptiste Nikiema1 and Jacques Simpore1,4
1Biomolecular Research Centre Pietro Annigoni (CERBA/LABIOGENE), University of Ouagadougou, Burkina Faso, West Africa; 2Institute of Research in Health Sciences, IRSS, Bobo-Dioulasso, Burkina Faso; 3Laboratory of Molecular and Cellular Biology, University of Sciences and Techniques of Masuku (USTM), Franceville, Gabon; 4Saint Camille Medical Centre, Ouagadougou, Burkina Faso; 5Population Health and Optimal Health Practices Research Unit, CHU de Quebec Research Centre, Quebec, Canada
ABSTRACT:
Background: Vertical human immunodeficiency virus (HIV) transmission is a public health problem in Burkina Faso. The main objective of this study on the prevention of mother-to-child HIV-1 transmission was to determine the residual risk of HIV transmission in infants born to mothers receiving highly active antiretroviral therapy (HAART). Moreover, we detect HIV antiretroviral (ARV) drug resistance among mother_infant pairs and identify subtypes and circulating recombinant forms (CRF) in Burkina Faso.
Design: In this study, 3,215 samples of pregnant women were analyzed for HIV using rapid tests. Vertical transmission was estimated by polymerase chain reaction in 6-month-old infants born to women who tested HIV positive. HIV-1 resistance to ARV, subtypes, and CRFs was determined through ViroSeq kit using the ABI PRISM 3,130 sequencer.
Results: In this study, 12.26% (394/3,215) of the pregnant women were diagnosed HIV positive. There was 0.52% (2/388) overall vertical transmission of HIV, with rates of 1.75% (2/114) among mothers under prophylaxis and 0.00% (0/274) for those under HAART. Genetic mutations were also isolated that induce resistance to ARV such as M184V, Y115F, K103N, Y181C, V179E, and G190A. There were subtypes and CRF of HIV-1 present, the most common being: CRF06_CPX (58.8%), CRF02_AG (35.3%), and subtype G (5.9%).
Conclusions: ARV drugs reduce the residual rate of HIV vertical transmission. However, the virus has developed resistance to ARV, which could limit future therapeutic options when treatment is needed. Resistance to ARV therefore requires a permanent interaction between researchers, physicians, and pharmacists, to strengthen the network of monitoring and surveillance of drug resistance in Burkina Faso.
Keywords: pregnant women; HAART; sequencing; genotypes; mutations
PMID: 25630709
Supplement
HIV screening for pregnant women
In the study site (Saint Camille Medical Center, Ouagadougou, Burkina Faso), Mother and child health service provide HIV voluntary test for pregnant women. HIV voluntary test for pregnant women in prenatal visit is the first step in a long process focused on Prevention of Mother To Child Transmission (PMTCT) but also on the care of infected families (1,2).
From October 2009 to June 2013, all of the 3215 pregnant women in prenatal consultation who had accept counseling for HIV test got their test result. The retrospective study health service records show that at this period, 12467 pregnant women were enrolled for first prenatal visit and only 3215 of them have accept to follow the counseling and also HIV test, with an adhesion rate of 25.79% (Table I). This brings out a high loss of adhesion rate between the time of prenatal visit and the time of HIV pre – test counseling.
Table I: Counseling and HIV test
| Items | Total |
| Prenatal visit | 12467 |
| Pre – test counseling | 3215 |
| Post – test counseling | 3215 |
| Adhesion rate | 3215/12467 (25.79%) |
| HIV + | 394/3215 (12.26%) |
| HIV – | 2821/3215 (87.74%) |
Most of pregnant women screened HIV positive were at their fourth pregnancy (Table II) or more (33.50% versus 12.69%: p <0.0001). But among pregnant women screened HIV negative, most of them were at their first pregnancy (38.36% versus 21.91%: p <0.0001).
Table II: Previous pregnancies among enrolled pregnant women
| Previous pregnancies | HIV negative (/2821) | HIV positive (/394) |
| First | 1082 (38.36%) | 50 (12.69%)1 |
| Second | 675 (23.93%) | 101 (25.63%) |
| Third | 446 (15.81%) | 111 (28.17%) |
| Fourth or more | 618 (21.91%) | 132 (33.50%)2 |
p (1 vs 2) < 0.0001
For effective care of patients infected with HIV, early diagnosis is needed. Also, for infected pregnant women, early diagnosis allows them to optimize their treatment, to improve their life quality increasing life expectancy and to use preventive measures to avoid HIV transmission to their children. In addition, during counseling (2), pregnant women diagnosed HIV negative will see the opportunity to be aware on the need to reflect on risks and so to modify some of practices.
References
1- Chérabi K et Nicolas J, 2004. Développement et Santé, n°173. http://devsante.org/base-documentaire/sante-publique-prevention/le-conseil-et-le-depistage-volontaire-du-vih
2- WHO, 2007. Guidance on provider-initiated HIV testing and counselling in health facilities. 60p. Geneve. ISBN 978 92 4 259556 7 http://www.who.int/hiv/pub/guidelines/9789241595568_en.pdf
Contact
Dr Tani SAGNA, PhD
Biomolecular Research Centre Pietro Annigoni (CERBA/LABIOGENE), University of Ouagadougou, Burkina Faso, West Africa
stanilinda@gmail.com