title: Protease inhibitor-based antiretroviral prophylaxis during pregnancy and the development of drug resistance.
abstract: BACKGROUND
  The aim of this study was to determine the development of drug resistance among pregnant women receiving a protease inhibitor-based antiretroviral prophylaxis for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV).
  
  
  METHODS
  HIV-infected pregnant women without maternal indication for antiretroviral therapy were enrolled prospectively. Genotypic resistance testing was performed prior to initiation of antiretroviral prophylaxis and was repeated 4-8 weeks after cessation of antiretroviral therapy at the time of delivery.
  
  
  RESULTS
  Forty pregnant women with HIV infection (Centers for Disease Control and Prevention stage A1 or A2) were included. All women received an antiretroviral regimen including either fixed-dose lopinavir/ritonavir (n = 33) or ritonavir-boosted saquinavir (n = 7) and a backbone consisting of 2 nucleoside reverse-transcriptase inhibitors. The mean duration of antiretroviral treatment was 8.4 weeks (range, 5-22 weeks). Primary resistance mutations were found in 2 patients (nonnucleoside reverse-transcriptase inhibitor resistance, K103N; protease inhibitor resistance, G48V). Postpartum genotypic resistance revealed no new relevant resistance mutations.
  
  
  CONCLUSIONS
  In our study no clinically significant resistance mutations developed in pregnant women receiving a short-term protease inhibitor-based antiretroviral regimen for prophylaxis of mother-to-child transmission of HIV. Future therapeutic options are therefore preserved.
authors.affiliation: Department of Obstetrics and Gynecology, Medizinische Poliklinik, University Hospital of Munich, Downtown Campus, Munich, Germany. andrea.gingelmaier@med.uni-muenchen.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Gingelmaier
authors.forename: Josef
authors.initials: J
authors.lastname: Eberle
authors.forename: Bernd P
authors.initials: BP
authors.lastname: Kost
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Bogner
authors.forename: Joerg
authors.initials: J
authors.lastname: Hofmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Weissenbacher
authors.forename: Ralph
authors.initials: R
authors.lastname: Kästner
authors.forename: Klaus
authors.initials: K
authors.lastname: Friese
authors.forename: Katharina
authors.initials: K
authors.lastname: Weizsaecker
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D020125:Mutation, Missense; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012367:RNA, Viral / Q000235:genetics; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral