title: Selection of HIV resistance associated with antiretroviral therapy initiated due to pregnancy and suspended postpartum.
abstract: OBJECTIVE
  Compare the risk of HIV drug resistance in women stopping suppressive nelfinavir (NFV)-based or Nevirapine (NVP)-based antiretroviral therapy (ART) after pregnancy.
  
  
  METHODS
  Specimens collected after stopping ART were tested for drug resistance by an oligonucleotide ligation assay and consensus sequencing. When postpartum drug resistance was detected, specimens obtained at study entry and during ART were evaluated.
  
  
  RESULTS
  Sixteen of 38 women with ART-induced suppression of viral replication suspended ART postpartum. Resistance mutations were detected in 75% who stopped NFV-ART and in 50% who stopped NVP-ART. M184V, associated with Lamivudine resistance, was more frequent among those randomized to NFV-ART compared with NVP-ART (6 of 8 versus 1 of 8; P = 0.04), and nonnucleoside reverse transcriptase inhibitor resistance was detected in 4 of 8 stopping NVP-ART.
  
  
  CONCLUSIONS
  HIV drug resistance was frequently observed among women who stopped suppressive NVP-ART or NFV-ART postpartum. This suggests that NFV-ART may have suboptimal potency, that staggering discontinuation of NVP-ART may be warranted, and/or ART adherence may be lax in women who choose to stop ART postpartum.
authors.affiliation: Center for Childhood Infections and Prematurity Research, Seattle Children's Research Institute, Seattle, WA 98101, USA.
authors.forename: Giovanina M
authors.initials: GM
authors.lastname: Ellis
authors.forename: Sharon
authors.initials: S
authors.lastname: Huang
authors.forename: Jane
authors.initials: J
authors.lastname: Hitti
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Frenkel
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D019888:Nelfinavir / Q000008:administration & dosage / Q000494:pharmacology; D019829:Nevirapine / Q000008:administration & dosage / Q000494:pharmacology; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D012641:Selection, Genetic
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine; D019888:Nelfinavir