Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration.
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.
Hudelson
Sarah E
SE
Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205, USA.
McConnell
Michelle S
MS
Bagenda
Danstan
D
Piwowar-Manning
Estelle
E
Parsons
Teresa L
TL
Nolan
Monica L
ML
Bakaki
Paul M
PM
Thigpen
Michael C
MC
Mubiru
Michael
M
Fowler
Mary Glenn
MG
Eshleman
Susan H
SH
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
D019380:Anti-HIV Agents; D019829:Nevirapine