AEGiS-14IAC: South African Intrapartum Nevirapine Trial : Selection of resistance mutations.

14th International AIDS Conference


Barcelona, Spain - July 7-12, 2002

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South African Intrapartum Nevirapine Trial : Selection of resistance mutations.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. LbPeB9024)

Sullivan J
University of Massachusetts Medical School, Worcester, United States

BACKGROUND: Selection of resistance mutations was determined in a trial of two doses of nevirapine (NVP) compared with 7 days of zidovudine/lamivudine (ZDV/3TC) for the prevention of MTCT of HIV.

METHODS: HIV genotyping was performed on plasma samples collected 4 to 6 weeks postpartum from 111 women receiving NVP, 37 women receiving ZDV/3TC and 40 HIV-1 infected infants born to mothers who had received NVP. HIV-1 genotyping was repeated on samples taken 9-12 months postpartum on 57 women who were previously studied.

RESULTS: NVP resistance mutations were detected in 74 (67%) of the 111 women who received two doses of NVP. The predominant NVP mutations found were K103N (62%) and Y181C (45%). Studies of 40 infected infants [4-6 wks/age] demonstrated NVP mutations in 21 of 40 (53%). The predominant mutation was Y181C present in 53%. Paired data from 26 mother infant pairs suggested that in a few instances NVP resistant virus may have been transmitted through breastfeeding. Long-term follow-up [9-12 months] samples were available from 57 women who were studied at 4-6 weeks postpartum. Of 36 women with NVP resistance mutations at 4-6 weeks, 28 (78%) reverted to wildtype and 8 (22%) retained NVP resistance. The K103N mutation was the most durable. No ZDV or 3TC mutations were detected in the 37 women who received the multiple dose ZDV/3TC regimen.

CONCLUSIONS: The use of a 2 dose maternal NVP regimen for prevention of MTCT is associated with a selection frequency (67%) of resistance mutations which is 3X greater than that observed with a single dose maternal regimen (19% HIVNET012). The majority of women who have NVP resistance mutations revert to wild type after 9-12 months. These results favor the use of single dose NVP or the 7 day ZDV/3TC regimens for the prevention of MTCT.

Keywords: AEGIS, Nevirapine, Zidovudine, Lamivudine, HIV-1, HIV Infections, HIV-1 Reverse Transcriptase, Mutation, Selection (Genetics), Human, Female, Infant, geneticsKWDaegis,nevirapine,zidovudine,lamivudine,hiv-1,hivinfections,hiv-1reversetranscriptase,mutation,selection(genetics),human,female,infant,genetics

020707
LbPeB9024

Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.