Nevirapine resistance after single dose prophylaxis

Susan H Eshleman; J Brooks Jackson

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Journal article

Nevirapine resistance after single dose prophylaxis

Susan H Eshleman and J Brooks Jackson

AIDS reviews, Vol.4(2), pp.59-63

04/2002

PMID: 12152519

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Abstract

Nevirapine (NVP) is a potent non-nucleoside inhibitor of HIV-1 reverse transcriptase. In 1999, the HIVNET 012 trial in Uganda demonstrated that a simple regimen of NVP prophylaxis can dramatically reduce the rate of HIV-1 mother-to-child transmission (MTCT). In the HIVNET 012 regimen, women received a single dose of NVP in labor, and infants received a single dose of NVP within 72 h of birth. The simplicity, efficacy, and low cost of the HIVNET 012 regimen are attractive for prevention of MTCT in resource-poor settings. Plans are underway to implement this regimen in several resource-poor countries. Single mutations in HIV-1 RT can cause high level NVP-resistance and are likely to exist in most HIV-1 infected patients at low levels prior to antiretroviral drug exposure. This favors emergence of NVP-resistant HIV-1 following NVP exposure. NVP-resistant HIV-1 has been shown to emerge in some women and infants following single dose NVP. Emergence of NVP-resistant HIV-1 in this setting is more common among women with high baseline viral loads and low baseline CD4 cell counts. The rate of NVP-resistance in women receiving single dose NVP prophylaxis may also be influenced by HIV-1 subtype. The NVP-resistant HIV-1 typically fades from detection in women and infants over time. We review studies examining the emergence and fading of NVP-resistant HIV-1 in women and infants who received single dose NVP prophylaxis, and discuss the potential clinical relevance of NVP-resistance in this setting.

HIV Infections - prevention & control

HIV-1 - drug effects

Humans

Infant

Nevirapine - therapeutic use

CD4 Lymphocyte Count

Pregnancy Complications, Infectious

HIV-1 - genetics

Viral Load

Pregnancy

Drug Resistance, Viral - genetics

Female

HIV Infections - transmission

Uganda

Mutation

Reverse Transcriptase Inhibitors - therapeutic use

Infectious Disease Transmission, Vertical - prevention & control

Details

Title: Subtitle: Nevirapine resistance after single dose prophylaxis
Creators: Susan H Eshleman - Department of Pathology, Johns Hopkins Medical Institutions, Ross Bldg. 646, 720 Rutland Ave., Baltimore, MD 21205, USA. seshlem@jhmi.edu
J Brooks Jackson
Resource Type: Journal article
Publication Details: AIDS reviews, Vol.4(2), pp.59-63
Publisher: Spain
PMID: 12152519
ISSN: 1139-6121
eISSN: 1698-6997
Grant note: N01-AI-35173 / NIAID NIH HHS U01-AI-46745 / NIAID NIH HHS U01-AI-48054 / NIAID NIH HHS N01-AI-45200 / NIAID NIH HHS N0I-AI-35173-417 / NIAID NIH HHS
Language: English
Date published: 04/2002
Academic Unit: Pathology; VPMA - Administration
Record Identifier: 9984047686102771

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