Breast-milk shedding of drug-resistant HIV-1 subtype C in women exposed to single-dose nevirapine.
Single-dose nevirapine reduces intrapartum human immunodeficiency virus 1 type (HIV-1) transmission but may also select for nonnucleoside reverse-transcriptase inhibitor (NNRTI) resistance in breast milk (BM) and plasma. Among 32 Zimbabwean women, median 8-week postpartum plasma and BM HIV-1 RNA levels were 4.57 and 2.13 log(10) copies/mL, respectively. BM samples from women with laboratory-diagnosed mastitis (defined as elevated BM Na(+) levels) were 5.4-fold more likely to have HIV-1 RNA levels above the median. BM RT sequences were not obtained for 12 women with BM HIV-1 RNA levels below the lower limit of detection of the assay used. In 20 paired BM and plasma samples, 65% of BM and 50% of plasma RT sequences had NNRTI-resistance mutations, with divergent mutation patterns.
Lee
Esther J
EJ
Center for AIDS Research, Division of Infectious Disease, Stanford University School of Medicine, Stanford, CA 94305, USA.
Kantor
Rami
R
Zijenah
Lynn
L
Sheldon
Wayne
W
Emel
Lynda
L
Mateta
Patrick
P
Johnston
Elizabeth
E
Wells
Jennifer
J
Shetty
Avinash K
AK
Coovadia
Hoosen
H
Maldonado
Yvonne
Y
Jones
Samuel Adeniyi
SA
Mofenson
Lynne M
LM
Contag
Christopher H
CH
Bassett
Mary
M
Katzenstein
David A
DA
D019380:Anti-HIV Agents / Q000008:administration & dosage*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission; D015497:HIV-1 / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008895:Milk, Human / Q000382:microbiology*; D019829:Nevirapine / Q000008:administration & dosage*; D011247:Pregnancy; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D019562:Viral Load; D017201:Virus Shedding; D015030:Zimbabwe
D019380:Anti-HIV Agents; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine