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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Nevirapine resistance by timing of HIV type 1 infection in infants treated with single-dose nevirapine
Clinical Infectious Diseases, Volume 50, No. 10, Year 2010
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Description
Background. In women, single-dose nevirapine for prophylaxis against mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) selects for nevirapine-resistant HIV-1, which subsequently decays rapidly. We hypothesized that the selection, acquisition, and decay of nevirapine-resistant HIV-1 differs in infants, varying by the timing of HIV-1 infection. Methods. We conducted a prospective, observational study of 740 Mozambican infants receiving single-dose nevirapine prophylaxis and determined the timing of infection and concentrations of nevirapine-resistant HIV-1 over time. Results. Infants with established in utero infection had a high rate (87.0%) of selection of nevirapine-resistant HIV-1 mutants, which rapidly decayed to undetectable levels. The few without nevirapine resistance received zidovudine with single-dose nevirapine and/or their mothers took alternative antiretroviral drugs. Infants with acute in utero infection had a lower rate of nevirapine-resistant HIV-1 (33.3%; P = .006, compared with established in utero infection), but mutants persisted over time. Infants with peripartum infection also had a lower rate of nevirapine-resistant HIV-1 (38.1%; P = .001, compared with established in utero infection) but often acquired 100% mutant virus that persisted over time (P= .017, compared with established in utero infection). Conclusions. The detection and persistence of nevirapine-resistant HIV-1 in infants after single-dose nevirapine therapy vary by the timing of infection and the antiretroviral regimen. In infants with persistent high-level nevirapine-resistant HIV-1, nevirapine-based antiretroviral therapy is unlikely to ever be efficacious because of concentrations in long-lived viral reservoirs. However, the absence or decay of nevirapine-resistant HIV-1 in many infants suggests that nevirapine antiretroviral therapy may be effective if testing can identify these individuals. © 2010 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Micek, Mark A.
United States
Departments of Global Health
United States, Seattle
Health Alliance International
Blanco, Ana Judith
United States, Seattle
Health Alliance International
Beck, Ingrid A.
United States, Seattle
Children's Hospital and Regional Medical Center
Dross, Sandra
United States, Seattle
Children's Hospital and Regional Medical Center
Matunha, Laurinda
United States, Seattle
Health Alliance International
Montoya, Pablo J.
United States
Departments of Global Health
United States, Seattle
Health Alliance International
Seidel, Kristy D.
United States, Seattle
Children's Hospital and Regional Medical Center
Gantt, Soren M.
United States, Seattle
University of Washington
United States, Seattle
Children's Hospital and Regional Medical Center
Matediane, Eduardo
Mozambique, Maputo
Mozambique Ministry of Health
Jamisse, Lilia
Mozambique, Maputo
Mozambique Ministry of Health
Gloyd, Stephen S.
United States
Departments of Global Health
United States, Seattle
Health Alliance International
Frenkel, Lisa M.
United States, Seattle
University of Washington
United States, Seattle
Children's Hospital and Regional Medical Center
Statistics
Citations: 41
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1086/652151
ISSN:
10584838
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Participants Gender
Female