title: Transmission of nevirapine-resistant HIV type 1 via breast milk to infants after single-dose nevirapine in Beira, Mozambique.
abstract: Acquisition of nevirapine (NVP)-resistant human immunodeficiency virus type 1 (HIV-1) by breast-feeding infants after receipt of single-dose NVP to prevent mother-to-child transmission is not well defined. A prospective observational study of 307 infants evaluated the rate of breast milk transmission of NVP-resistant HIV and the concentrations of mutants over time. NVP resistance was detected in 9 of 24 infants (37.5%; 95% confidence interval, 18.8%-59.4%) infected via breast milk. Eight had a pure mutant HIV population at the time infection was first detected, and majority mutant populations persisted in all 6 infants with follow-up specimens. Infection of breast-feeding infants with NVP-resistant HIV resulted in mutants persisting as the dominant virus, which may indefinitely compromise treatment with NVP-based antiretroviral regimens.
authors.affiliation: University of Washington Health Alliance International.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Micek
authors.affiliation: University of Washington Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Sandra
authors.initials: S
authors.lastname: Dross
authors.affiliation: University of Washington Health Alliance International.
authors.forename: Ana Judith
authors.initials: AJ
authors.lastname: Blanco
authors.affiliation: Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Beck
authors.affiliation: Health Alliance International.
authors.forename: Laurinda
authors.initials: L
authors.lastname: Matunha
authors.affiliation: Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Kristy
authors.initials: K
authors.lastname: Seidel
authors.affiliation: University of Washington Health Alliance International.
authors.forename: Pablo
authors.initials: P
authors.lastname: Montoya
authors.affiliation: Mozambique Ministry of Health, Maputo.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Matediana
authors.affiliation: University of Washington Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Soren
authors.initials: S
authors.lastname: Gantt
authors.affiliation: University of Washington Health Alliance International.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gloyd
authors.affiliation: University of Washington Seattle Children's Research Institute, Seattle, Washington;
authors.forename: Lisa
authors.initials: L
authors.lastname: Frenkel
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects; D001942:Breast Feeding / Q000009:adverse effects; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008895:Milk, Human / Q000821:virology*; D009073:Mozambique; D019829:Nevirapine / Q000008:administration & dosage* / Q000009:adverse effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine
keywords: HIV-1; drug-resistance; mother-to-child transmission; nevirapine; zidovudine