Since the introduction of antiretroviral therapy (ART), remarkable progress has been made in the global fight against HIV/AIDS. Particularly in the prevention of mother-to-child transmission, the achievements have been significant: since 2010, new HIV infections among children worldwide have dropped by 62%, and in 2024, approximately 84% of pregnant women living with HIV received antiretroviral drugs.
However, behind these numbers lies a lingering challenge. Even in Rwanda, where ART coverage is as high as 97.5%, about 0.9% of infants were still infected with HIV by their mothers in 2024. Who are these “missed cases”? Why does the virus still break through these defences and transmit to children, even when mothers adhere to their treatment?
Recently, a major research study, conducted collaboratively by the University of Rwanda, Rwanda Biomedical Centre, Makerere University, Soroti University, and the Uganda National Health Laboratory and Diagnostic Services, was published in the American Journal of Health, Medicine and Nursing Practice. The study, titled “Mother-to-Child Transmission of Drug Resistant HIV-1 in Selected PMTCT Clinics in Rwanda,” reveals for the first time the critical mechanisms and epidemiological characteristics of drug-resistant HIV-1 mother-to-child transmission in Rwanda.
It is worth noting that this marks the first time in Africa that MGI’s whole workflow solutions have been used in HIV prevention and control research. The HIV-1 resistance sequencing assay product demonstrated excellent performance in this research project, enabling precise identification of viral resistance mutations. This provides a more robust, stable, and cost-effective solution for optimizing HIV prevention and control strategies and improving the prevention of mother-to-child transmission in Africa.
The research team followed 862 HIV-positive pregnant women and their infants for 18 months and found that even with ART coverage as high as 97.5%, 32 cases of mother-to-child transmission were still recorded. Notably, 28% of the infected infants carried HIV strains that were already resistant to first-line drugs—and these drug-resistant strains were directly transmitted from their mothers. The team then conducted in-depth drug resistance analysis and subtyping of the mother–infant pairs using MGI’s ATOPlex HIV-1 Library Prep Kit Set, the G99 sequencer, and HIV-Genome Pro software.
The results showed:
- The K103N mutation (conferring resistance to efavirenz and nevirapine) was detected in 22% of mothers and 19% of infants, with a transmission rate as high as 100%
The M184V mutation (conferring resistance to lamivudine and emtricitabine) was found in 25% of mothers and 30% of infants, with a transmission rate of 83%
Other resistance mutations such as V108I, E138A, and M41L were also detected, along with diverse HIV-1 subtypes including A1, D, and recombinant forms, indicating high viral diversity.
This means that even if infants receive standard preventive treatment immediately after birth, these drugs may be ineffective from the start if they are infected with drug-resistant strains from their mothers. This study highlights that in the fight against HIV, increasing ART coverage alone is no longer sufficient to fully prevent mother-to-child transmission. Drug resistance monitoring must become an essential component of PMTCT programmes.
In the field of HIV sequencing, MGI has launched the HIV-1 Drug Resistance Sequencing Products Package and the HIV-1 Full-Length Genome Sequencing Products Package. MGI will continue to leverage its leading sequencing technologies and solutions to support global HIV prevention and control efforts, protect more children from infection, and help every mother safely bring a healthy child into the world.
