Nevirapine resistance after single dose prophylaxis

Susan H. Eshleman, J. Brooks Jackson

Research output: Contribution to journalReview articlepeer-review

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 influence 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.

Original languageEnglish (US)
Pages (from-to)59-63
Number of pages5
JournalAIDS Reviews
Volume4
Issue number2
StatePublished - 2002

Keywords

  • HIV-1
  • Mother-to-child transmission
  • Nevirapine
  • Prophylaxis
  • Resistance

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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