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Impact of Maternal and Infant Antiretroviral Drug Regimens on Drug Resistance in HIV-Infected Breastfeeding Infants.

Fogel, J. M., Mwatha, A., Richardson, P., Brown, E. R., Chipato, T., Alexandre, M., Moodley, D., Elbireer, A., Mirochnick, M., George, K., Mofenson, L. M., Zwerski, S., Coovadia, H. M. and Eshleman, S. H. (2012) Impact of Maternal and Infant Antiretroviral Drug Regimens on Drug Resistance in HIV-Infected Breastfeeding Infants. The Pediatric infectious disease journal. ISSN 1532-0987

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Abstract

The HPTN 046 trial evaluated the efficacy of extended infant nevirapine (NVP) administration for prevention of HIV transmission through breastfeeding. Infants received daily NVP to 6 weeks of age. HIV-uninfected infants (the intent-to-treat group) received daily NVP or placebo up to 6 months of age. We analyzed emergence of NVP resistance in infants who acquired HIV-infection despite prophylaxis.HIV genotyping was performed using the ViroSeq HIV Genotyping System. Medians and proportions were used to summarize data. Two-sided Fisher's exact tests were used to evaluate associations between categorical variables. NVP resistance was detected in 12 (92.3%) of 13 infants who were HIV-infected by 6 weeks and in seven (28%) of 25 infants who were HIV-uninfected at 6 weeks and HIV-infected at 6 months of age (6/8=75% in the NVP arm, 1/17=5.9% in the placebo arm, P=0.001). Among those 25 infants, 4 had mothers who initiated an antiretroviral (ARV) treatment regimen by 6 months postpartum. In all 4 cases, the treatment regimen included a non-nucleoside reverse transcriptase inhibitor (NVP or efavirenz). NVP resistance was detected in all four of those infants by 6 months of age (4/4=100%). In contrast, only three (14.2%) of the remaining 21 HIV-infected infants whose mothers did not initiate ARV treatment developed NVP resistance (P=0.003). Extended NVP prophylaxis significantly increased the risk of NVP resistance in infants who acquired HIV infection after 6 weeks of age. Treatment of maternal HIV infection was also associated with emergence of NVP resistance in HIV-infected, breastfed infants.

Item Type: Article
Keywords: Maternal and Infant Antiretroviral Drug Regimens;Drug Resistance;HIV-Infected Breastfeeding Infants
Subjects: HIV > Treatment
Divisions: Other
Related URLs:
Depositing User: Mr Joseph Madata
Date Deposited: 15 Jan 2013 08:19
Last Modified: 15 Jan 2013 08:19
URI: http://ihi.eprints.org/id/eprint/1029

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