Zidovudine with nevirapine for the prevention of HIV mother-to-child transmission reduces nevirapine resistance in mothers from the Western Cape, South Africa

J Med Virol. 2008 Jun;80(6):942-6. doi: 10.1002/jmv.21157.

Abstract

In the Western Cape province of South Africa, an intensified regimen for the prevention-of-mother-to-child-transmission-of-HIV consisting of zidovudine (AZT) from 34 weeks of pregnancy plus single dose (sd) nevirapine (NVP) during labor was instituted in 2004. The newborn baby receives a single dose of NVP and AZT for 7 days. Similar strategies in Thailand and Africa have been shown to be more effective in reducing transmission than NVP alone. The use of sd NVP only for the prevention-of-mother-to-child-transmission-of-HIV has a high risk of inducing resistance (25-69%) with an average of 35.7% by a recent meta-analysis and has been shown to adversely affect non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy when initiated within 6 months. In this study the prevalence of resistance to NVP and AZT in mothers who had received the intensified regimen was measured. Specimens collected from mothers were genotyped by in-house PCR and sequencing. In specimens obtained within 60 days of delivery, acquired NVP resistance mutations were detected in 13 of 76 patients (17.1%, 95% confidence interval: 8.7-25.6%), which appears to be lower than in studies with sd NVP alone (37.5%, 95% confidence interval: 23.0-50.6%).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / pharmacology
  • Anti-HIV Agents / therapeutic use
  • Drug Resistance, Viral / drug effects
  • Drug Resistance, Viral / genetics*
  • Female
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • HIV Infections / virology*
  • HIV Reverse Transcriptase / genetics
  • HIV-1 / drug effects
  • HIV-1 / enzymology
  • HIV-1 / genetics*
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Mutation
  • Nevirapine / pharmacology
  • Nevirapine / therapeutic use*
  • Pregnancy
  • South Africa
  • Zidovudine / pharmacology
  • Zidovudine / therapeutic use*

Substances

  • Anti-HIV Agents
  • Zidovudine
  • Nevirapine
  • HIV Reverse Transcriptase