title: HIV drug resistance in mothers and infants following use of antiretrovirals to prevent mother-to-child transmission.
abstract: The purpose of this article is to review prominent studies on HIV drug-resistance in mothers and their infants after the use of antiretroviral drugs to prevent mother-to-child-transmission in resource-limited communities. The effects of drug-resistance on subsequent combination antiretroviral therapy are discussed, as are the probable mechanisms of acquisition and decay or persistence of drug-resistant mutants. Differences in the rates of HIV drug-resistance from interventions used to prevent mother-to-child-transmission in North America and Europe are contrasted to the simplified regimens used in resource-limited settings. Unresolved issues related to HIV drug-resistance are reviewed, including: whether maternal zidovudine monotherapy selects significant resistance; the clinical relevance of HIV drug-resistant variants selected by single-dose nevirapine that persist as minority viral variants and can affect the outcome of non-nucleoside reverse transcriptase inhibitor-based therapy; and the use of maternal combination antiretroviral therapy during breastfeeding. Finally, the current and upcoming strategies to reduce HIV drug-resistance related to use of antiretrovirals to prevent mother-to-child-transmission are discussed and contrasted with the challenges of financing and administering antiretrovirals to prevent mother-to-child-transmission in resource-limited communities.
authors: University of Washington, WA, USA.
authors: Quy
authors: Q
authors: Ton
authors: Lisa
authors: L
authors: Frenkel
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage; D052157:Aptamers, Nucleotide; D048588:Benzoxazines / Q000008:administration & dosage; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D003906:Developing Countries; D004334:Drug Administration Schedule; D024882:Drug Resistance, Viral / Q000276:immunology; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D009035:Mothers; D019829:Nevirapine / Q000008:administration & dosage; D017354:Point Mutation / Q000187:drug effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D060888:Real-Time Polymerase Chain Reaction; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage; D018571:Sentinel Surveillance; D017422:Sequence Analysis, DNA; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D052157:Aptamers, Nucleotide; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine; D019829:Nevirapine; C098320:efavirenz