title: Emergence of drug resistant mutations after single dose nevirapine exposure in HIV-1 infected pregnant women in south India.
abstract: OBJECTIVE
  Resistance to nevirapine (NVP) has been described with single dose preventive regimens in other populations. Our aim was to study the pattern and prevalence of HIV drug resistance (DR) at baseline (during pregnancy) and after delivery among antenatal women exposed to single dose NVP for prevention of parent to child transmission (PPTCT).
  
  
  METHODS
  HIV-infected, ART-naive primigravidae between 18-25 years of age, attending government antenatal clinics in Chennai, Vellore or Madurai were recruited. Drug resistance testing was carried out during pregnancy and after Sd-NVP treatment (one month after delivery) by Viroseq sequencing. HIV-1 testing by DNA PCR was done in newborns at 30 days.
  
  
  RESULTS
  Thirty one women were enrolled but only twenty six plasma specimens were analyzable (24 paired and two postnatal only). No major mutations were observed in any drug class at baseline though many polymorphisms were observed in both the reverse transcriptase and protease genes. Mutations to non-nucleoside reverse transcriptase inhibitors (NNRTI) were observed post-delivery in 33 per cent of women who were treated with Sd-NVP. None of the infants were HIV-positive.
  
  
  CONCLUSIONS
  Among pregnant ART-naive women, baseline HIV drug resistance was not observed. A high rate of development of NNRTI class resistance among women treated with single-dose NVP was observed. Our results emphasize the need to implement more effective PPTCT regimens, minimizing emergence of drug resistance and thereby preserving long-term treatment options for HIV-infected women in India.
authors.affiliation: Tuberculosis Research Centre (ICMR), Chennai, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Rajesh
authors.forename: K
authors.initials: K
authors.lastname: Ramesh
authors.forename: Luke Elizabeth
authors.initials: LE
authors.lastname: Hanna
authors.forename: P R
authors.initials: PR
authors.lastname: Narayanan
authors.forename: Soumya
authors.initials: S
authors.lastname: Swaminathan
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001483:Base Sequence; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D007194:India; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics; D019829:Nevirapine / Q000627:therapeutic use*; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D017422:Sequence Analysis, DNA; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine