title: Emergence of drug-resistant HIV-1 after intrapartum administration of single-dose nevirapine is substantially underestimated.
abstract: Conventional sequence analysis detects human immunodeficiency virus (HIV)-1 drug resistance mutations in approximately 40% of women shortly after they receive intrapartum single-dose nevirapine (SD-NVP). Using sensitive real-time polymerase chain reaction assays for the K103N and Y181C resistance mutations, we tested genotyped virus before and after SD-NVP in 50 South African women infected with HIV-1 subtype C. By sequence analysis, 40 women had no detectable resistance mutations, and an additional 6 women were negative for Y181C after SD-NVP. We found K103N in 16 (40%) of 40 women and Y181C in 5 (11%) of 46 women at 6-36 weeks postpartum. Clonal sequencing confirmed K103N in 5 of 5 representative samples and Y181C in 4 of 4 samples. Four of the 5 women with newly identified Y181C also had K103N. These findings indicate that resistance mutations emerged in at least 65% of the women after SD-NVP and emphasize the importance of further research to determine the clinical implications.
authors.affiliation: Laboratory Branch, National Center for HIV, STD, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. jjohnson1@cdc.gov
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Jin-Fen
authors.initials: JF
authors.lastname: Li
authors.forename: Lynn
authors.initials: L
authors.lastname: Morris
authors.forename: Neil
authors.initials: N
authors.lastname: Martinson
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.forename: James
authors.initials: J
authors.lastname: McIntyre
authors.forename: Walid
authors.initials: W
authors.lastname: Heneine
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology*; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009154:Mutation; D019829:Nevirapine / Q000008:administration & dosage / Q000494:pharmacology*; D011247:Pregnancy; D014764:Viral Proteins / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D014764:Viral Proteins; D019829:Nevirapine