gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Successful and rapid reduction of viral load one week prior to C-section with ART including enfuvirtide

Erfolgreiche und schnelle Senkung der Viruslast innerhalb einer Woche vor geplanter Sectio mit Enfuvirtid-haltiger ART

Meeting Abstract

  • J. Thoden - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Rheumatologie und Klin. Immunologie, Freiburg, Germany
  • S. Usadel - Praxis Usadel, Freiburg, Germany; Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany
  • H. Löffler - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Zentrum für Kinder- und Jugendmedizin, Freiburg, Germany
  • M. Kunze - Universitäts-Frauenklinik Freiburg, Germany
  • D. Wagner - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Zentrum für Infektiologie und Reisemedizin, Freiburg, Germany
  • W.V. Kern - Universitätsklinikum Freiburg, Centrum für Chronische Immundefizienz – CCI, Freiburg, Germany; Universitätsklinikum Freiburg, Zentrum für Infektiologie und Reisemedizin, Freiburg, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP137

DOI: 10.3205/10kit191, URN: urn:nbn:de:0183-10kit1915

Veröffentlicht: 2. Juni 2010

© 2010 Thoden et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Prevention of MTCT is mainly based on a reduction of maternal viral load (VL) <1000 c/ml prior to delivery. Late presenters are at increased risk of transmitting HIV to the newborn. According to the German-Austrian recommendations antiretroviral therapy (ART) during pregnancy is either started for maternal indication (CD4 <350/µl) or for fetal indication around 32 weeks of gestational age, usually consisting of an AZT/3TC and PI-based regimen (LPV/r or SQV/r) (http://www.uni-duesseldorf.de/AWMF/ll/055-002.htm). Enfuvirtide (T20) has previously been successfully and safely given to pregnant women, especially in the setting of multidrug resistance or when a rapid reduction of VL was needed. About 30 cases have been published yet. Nevertheless the experience with this drug during pregnancy is limited (Haberl A et al. Use of Enfuvirtide in HIV+ Pregnant Women [Abstract 627b]. CROI. 2008).

Case report: We report a 24 yo African woman (G1P1) diagnosed HIV-positive during the 27th week of pregnancy (CD4 51/µl [4.6%]; VL of 1.3 mio c/ml at diagnosis). Resistance testing revealed a wild type virus. ART was initiated with TDF/FTC/SQV/r. At 30 weeks the CD4 count had risen to 149/µl (10.5%) and VL was 2,000 c/ml. At 32 weeks gestational age when she presented with abdominal pain, CD4 count was 51/µl (8.5%) and VL 20,000c/ml. At week 37 CD4 count was still low (49/µl [(7%]) and VL was dramatically increased to 800,000 c/ml. The patient now admitted poor adherence and was admitted to the obstetrics ward for directly observed therapy. ART was switched to AZT/3TC/NVP and T20 due to suspected resistance and for rapid reduction of VL prior to C-section to reduce the risk of MTCT. Within nine days the VL was reduced to 7,000 c/ml and a C-section done. After delivery the maternal ART was switched to TDF/FTC/NVP and has had a virologically and immunologically successful response since. Antepartum the mother received AZT i.v., the child received prophylactic ART for 6 weeks consisiting of AZT/3TC and NVP. HIV-PCR remained negative at 4 months of age.

Conclusions: T20 can be a safe and powerful intensification to ART in late-presenting HIV-positive pregnant women to prevent MTCT. It is generally well tolerated and does not cross the placental barrier. Observed injecting of T20 improves adherence and can lead to a rapid VL reduction. In the case presented here a 2log reduction in one week prior to c-section was achieved.