Journal article
Frequent nevirapine resistance in infants infected by HIV-1 via breastfeeding while on nevirapine prophylaxis
AIDS (London), Vol.29(16), pp.2131-2138
10/23/2015
DOI: 10.1097/QAD.0000000000000814
PMCID: 4715989
PMID: 26186128
Abstract
Objective:The objective of this study is to assess nevirapine (NVP) resistance in infants who became infected in the three arms of the Breastfeeding, Antiretrovirals and Nutrition (BAN) study: daily infant NVP prophylaxis, triple maternal antiretrovirals or no extra intervention for 28 weeks of breastfeeding.
Design:A prospective cohort study.
Methods:The latest available plasma or dried blood spot specimen was tested from infants who became HIV-positive between 3 and 48 weeks of age. Population sequencing was used to detect mutations associated with reverse transcriptase inhibitor resistance. Sequences were obtained from 22 out of 25 transmissions in the infant-NVP arm, 23 out of 30 transmissions in the maternal-antiretroviral arm and 33 out of 38 transmissions in the control arm.
Results:HIV-infected infants in the infant-NVP arm were significantly more likely to have NVP resistance than infected infants in the other two arms of the trial, especially during breastfeeding through 28 weeks of age (56% in infant-NVP arm vs. 6% in maternal-antiretroviral arm and 11% in control arm, P=0.004). There was a nonsignificant trend, suggesting that infants with NVP resistance tended to be infected earlier and exposed to NVP while infected for a greater duration than infants without resistance.
Conclusion:Infants on NVP prophylaxis during breastfeeding are at a reduced risk of acquiring HIV, but are at an increased risk of NVP resistance if they do become infected. These findings point to the need for frequent HIV testing of infants while on NVP prophylaxis, and for the availability of antiretroviral regimens excluding NVP for treating infants who become infected while on such a prophylactic regimen. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.
Details
- Title: Subtitle
- Frequent nevirapine resistance in infants infected by HIV-1 via breastfeeding while on nevirapine prophylaxis
- Creators
- Julie A. E. Nelson - AIDS UnitedAli Fokar - University of North Carolina at Chapel HillMichael G. Hudgens - University of North Carolina at Chapel HillKara J. Compliment - AIDS UnitedJustin Tyler Hawkins - AIDS UnitedGerald Tegha - Univ North Carolina Project, Lilongwe, MalawiDeborah D. Kamwendo - Univ North Carolina Project, Lilongwe, MalawiDumbani Kayira - Univ North Carolina Project, Lilongwe, MalawiInnocent A. Mofolo - Univ North Carolina Project, Lilongwe, MalawiAthena P. Kourtis - Centers for Disease Control and PreventionDenise J. Jamieson - Centers for Disease Control and PreventionCharles M. Van Der Horst - University of North Carolina at Chapel HillSusan A. Fiscus - AIDS United
- Resource Type
- Journal article
- Publication Details
- AIDS (London), Vol.29(16), pp.2131-2138
- DOI
- 10.1097/QAD.0000000000000814
- PMID
- 26186128
- PMCID
- 4715989
- NLM abbreviation
- AIDS
- ISSN
- 0269-9370
- eISSN
- 1473-5571
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Grant note
- R24 TW007988 / Fogarty International Clinical Research Scholars Programme Elizabeth Glaser Pediatric AIDS Foundation U01-AI068632 / IMPAACT Network through UNC IMPAACT Specialty Laboratory U.S. Agency for International Development; United States Agency for International Development (USAID) DHHS/NIH/FIC 2-D43 TW01039-06 / NIH Fogarty AIDS International Training and Research Programme World Food Programme P30-AI50410 / UNC Center for AIDS Research M01RR016587 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA Malawi Ministry of Health and Population United Nations Children's Fund U01AI068632 / NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) R24TW007988 / FOGARTY INTERNATIONAL CENTER; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) SIP13-01 U48-CCU409660-09 / Prevention Research Centers Special Interest Project of the Centers for Disease Control and Prevention
- Language
- English
- Date published
- 10/23/2015
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446439502771
Metrics
7 Record Views