In utero HIV infection is associated with an increased risk of nevirapine resistance in ugandan infants who were exposed to perinatal single dose nevirapine.
Use of single dose nevirapine (sdNVP) to prevent HIV mother-to-child transmission is associated with the emergence of NVP resistance in many infants who are HIV infected despite prophylaxis. We combined results from four clinical trials to analyze predictors of NVP resistance in sdNVP-exposed Ugandan infants. Samples were tested with the ViroSeq HIV Genotyping System and a sensitive point mutation assay (LigAmp, for detection of K103N, Y181C, and G190A). NVP resistance was detected at 6-8 weeks in 36 (45.0%) of 80 infants using ViroSeq and 33 (45.8%) of 72 infants using LigAmp. NVP resistance was more frequent among infants who were infected in utero than among infants who were diagnosed with HIV infection after birth by 6-8 weeks of age. Detection of NVP resistance at 6-8 weeks was not associated with HIV subtype (A vs. D), pre-NVP maternal viral load or CD4 cell count, infant viral load at 6-8 weeks, or infant sex. NVP resistance was still detected in some infants 6-12 months after sdNVP exposure. In this study, in utero HIV infection was the only factor associated with detection of NVP resistance in infants 6-8 weeks after sdNVP exposure.
Church
Jessica D
JD
Johns Hopkins University School of Medicine , Baltimore, Maryland 21205, USA.
Mwatha
Anthony
A
Bagenda
Danstan
D
Omer
Saad B
SB
Donnell
Deborah
D
Musoke
Philippa
P
Nakabiito
Clemensia
C
Eure
Chineta
C
Bakaki
Paul
P
Matovu
Flavia
F
Thigpen
Michael C
MC
Guay
Laura A
LA
McConnell
Michelle
M
Fowler
Mary Glenn
MG
Jackson
J Brooks
JB
Eshleman
Susan H
SH
D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D019829:Nevirapine / Q000008:administration & dosage*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D012367:RNA, Viral / Q000032:analysis / Q000187:drug effects / Q000235:genetics; D014454:Uganda; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral; D019829:Nevirapine