title: Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration.
abstract: OBJECTIVE
  Single-dose nevirapine (NVP) (sdNVP) can reduce the risk of HIV vertical transmission. We assessed risk factors for NVP resistance in plasma and breast milk from sdNVP-exposed Ugandan women.
  
  
  METHODS
  Samples were analyzed using the Roche AMPLICOR HIV-1 Monitor Test Kit, version 1.5, and the ViroSeq HIV-1 Genotyping System. NVP concentrations were determined by liquid chromatography with tandem mass spectroscopy.
  
  
  RESULTS
  HIV genotypes (plasma and breast milk) were obtained for 30 women 4 weeks after sdNVP (HIV subtypes: 15A, 1C, 12D, two recombinant). NVP resistance was detected in 12 (40%) of 30 breast milk samples. There was a nonsignificant trend between detection of NVP resistance in breast milk and plasma (P = 0.06). There was no association of HIV resistance in breast milk with median maternal pre-NVP viral load or CD4 cell count, median breast milk viral load at 4 weeks, breast milk sodium more than 10 mmol/l, HIV subtype, or concentration of NVP in breast milk or plasma.
  
  
  CONCLUSIONS
  NVP resistance was frequently detected in breast milk 4 weeks after sdNVP exposure. In this study, we were unable to identify specific factors associated with breast milk NVP resistance.
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hudelson
authors.forename: Michelle S
authors.initials: MS
authors.lastname: McConnell
authors.forename: Danstan
authors.initials: D
authors.lastname: Bagenda
authors.forename: Estelle
authors.initials: E
authors.lastname: Piwowar-Manning
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Parsons
authors.forename: Monica L
authors.initials: ML
authors.lastname: Nolan
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.forename: Michael C
authors.initials: MC
authors.lastname: Thigpen
authors.forename: Michael
authors.initials: M
authors.lastname: Mubiru
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
authors.forename: Susan H
authors.initials: SH
authors.lastname: Eshleman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D002853:Chromatography, Liquid; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008895:Milk, Human / Q000737:chemistry / Q000821:virology*; D019829:Nevirapine / Q000032:analysis / Q000378:metabolism / Q000627:therapeutic use*; D011247:Pregnancy; D014454:Uganda; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine