Journal Article

Antiretroviral Resistance Patterns and HIV-1 Subtype in Mother-Infant Pairs after the Administration of Combination Short-Course Zidovudine plus Single-Dose Nevirapine for the Prevention of Mother-to-Child Transmission of HIV

Amphan Chalermchockcharoenkit, Mary Culnane, Tawee Chotpitayasunondh, Nirun Vanprapa, Wanna Leelawiwat, Philip A. Mock, Suvanna Asavapiriyanont, Achara Teeraratkul, Michelle S. McConnell, Janet M. McNicholl and Jordan W. Tappero

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 2, pages 299-305
Published in print July 2009 | ISSN: 1058-4838
Published online July 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/599612
Antiretroviral Resistance Patterns and HIV-1 Subtype in Mother-Infant Pairs after the Administration of Combination Short-Course Zidovudine plus Single-Dose Nevirapine for the Prevention of Mother-to-Child Transmission of HIV

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Background.World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B.

Methods.Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare).

Results.Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, P=.002>for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P=.038).

Conclusions.The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.

Journal Article.  4172 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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