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Impact of maternal and infant antiretroviral drug regimens on drug resistance in HIV-infected breastfeeding infants.

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dc.contributor.authorFogel, Jessica M.
dc.contributor.authorMwatha, Anthony.
dc.contributor.authorBrown, Elizabeth R.
dc.contributor.authorRichardson, Paul.
dc.contributor.authorChipato, Tsungai.
dc.contributor.authorAlexandre, Michel.
dc.contributor.authorMoodley, Dhayendre.
dc.contributor.authorElbireer, Ali.
dc.contributor.authorMirochnick, Mark.
dc.contributor.authorGeorge, Kathleen.
dc.contributor.authorMofenson, Lynne Meryl.
dc.contributor.authorZwerski, Sheryl.
dc.contributor.authorEshleman, Susan H.
dc.contributor.authorCoovadia, Hoosen Mahomed.
dc.date.accessioned2016-09-13T13:04:01Z
dc.date.available2016-09-13T13:04:01Z
dc.date.created2013
dc.date.issued2013
dc.descriptionThe 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.en_US
dc.description.abstractBackground: The HIV Prevention Trials Network (HPTN) 046 trial evaluated the efficacy of extended infant nevirapine (NVP) administration for prevention of HIV transmission through breastfeeding. Infants received daily NVP up 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. Methods: HIV genotyping was performed using the ViroSeq HIV Genotyping System. Medians and proportions were used to summarize data. Two-sided Fisher exact tests were used to evaluate associations between categorical variables. Results: NVP resistance was detected in 12 (92.3%) of 13 infants who were HIV-infected by 6 weeks and in 7 (28%) of 25 infants who were HIVuninfected 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 treatment regimen by 6 months postpartum. In all 4 cases, the treatment regimen included a nonnucleoside reverse transcriptase inhibitor (NVP or efavirenz). NVP resistance was detected in all 4 of those infants by 6 months of age (4/4 = 100%). In contrast, only 3 (14.2%) of the remaining 21 HIV-infected infants whose mothers did not initiate antiretroviral treatment developed NVP resistance (P = 0.003). Conclusions: 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.en_US
dc.identifier.citationFogel, 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.; Eshleman, S.H. 2013. Impact of maternal and infant antiretroviral drug regimens on drug resistance in HIV-infected breastfeeding infants. The Pediatric infectious disease journal 32(4), 164-169..en_US
dc.identifier.urihttp://dx.doi.org/10.1097/INF.0b013e31827f44eeen_US
dc.identifier.urihttp://hdl.handle.net/10413/13343
dc.language.isoenen_US
dc.publisherPediatric Infectious Disease Journalen_US
dc.subjectNevirapine resistance.en_US
dc.subjectPrevention of mother-to-child transmission.en_US
dc.subjectExtended nevirapine.en_US
dc.subjectHIV.en_US
dc.titleImpact of maternal and infant antiretroviral drug regimens on drug resistance in HIV-infected breastfeeding infants.en_US
dc.typePeer reviewed journal articleen_US

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