title: In utero HIV infection is associated with an increased risk of nevirapine resistance in ugandan infants who were exposed to perinatal single dose nevirapine.
abstract: 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.
authors: Johns Hopkins University School of Medicine , Baltimore, Maryland 21205, USA.
authors: Jessica D
authors: JD
authors: Church
authors: Anthony
authors: A
authors: Mwatha
authors: Danstan
authors: D
authors: Bagenda
authors: Saad B
authors: SB
authors: Omer
authors: Deborah
authors: D
authors: Donnell
authors: Philippa
authors: P
authors: Musoke
authors: Clemensia
authors: C
authors: Nakabiito
authors: Chineta
authors: C
authors: Eure
authors: Paul
authors: P
authors: Bakaki
authors: Flavia
authors: F
authors: Matovu
authors: Michael C
authors: MC
authors: Thigpen
authors: Laura A
authors: LA
authors: Guay
authors: Michelle
authors: M
authors: McConnell
authors: Mary Glenn
authors: MG
authors: Fowler
authors: J Brooks
authors: JB
authors: Jackson
authors: Susan H
authors: SH
authors: Eshleman
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D019829:Nevirapine