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Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Clinical Infectious Diseases. 2009 Jul 15; 49(2):299-305.BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
Geneva, Switzerland, WHO, 2003. 79 p.The purposes of the HDRST include: 1) to work with the National AIDS Committee to consider the specific public health uses of HIV drug resistance surveillance in the country, and to assess feasibility of surveillance; 2) to develop an appropriate time line for resistance surveillance activities, in coordination with other important implementation plans such as expanding HIV treatment; 3) to assess the country's capacity for HIV drug resistance surveillance, to decide on the populations and groups to be targeted, and to identify additional resources and activities needed; 4) to perform HIV drug resistance threshold surveys to assess when the frequency of resistance in persons newly diagnosed with HIV has reached the 5% threshold indicating a need for resistance surveillance; 5) to implement, when appropriate, HIV drug resistance surveillance; 6) to collaborate with the National AIDS Committee and the national treatment programme; to explore the feasibility of treatment programme monitoring by adding a resistance monitoring component to other year-end programme monitoring activities; 7) after routine surveillance is established, to consider implementing other special studies for in-depth evaluation of certain aspects of drug resistance within the country; 8) to insure implementation of all activities in accordance with international ethical standards designed to promote the well- being and health of individuals and communities; 9) to insure the dissemination of results in order to promote and support the public health of the country. (excerpt)