Zidovudine With Nevirapine for the Prevention of HIV Mother-to-Child Transmission Reduces Nevirapine Resistance in Mothers From the Western Cape, South Africa

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Abstract

In the Western Cape province of South Africa, an intensified regimen for the prevention-ofmother-to-child-transmission-of-HIV consisting of zidovudine (AZT) from 34 weeks of pregnancy plus single dose (sd) nevirapine (NVP) during labor was instituted in 2004. The newborn baby receives a single dose of NVP and AZT for 7 days. Similar strategies in Thailand and Africa have been shown to be more effective in reducing transmission than NVP alone. The use of sd NVP only for the prevention-of-mother-to-childtransmission-of-HIV has a high risk of inducing resistance (25-69%) with an average of 35.7% by a recent meta-analysis and has been shown to adversely affect non-nucleoside reverse transcriptase inhibitor (NNRTI)-based antiretroviral therapy when initiated within 6 months. In this study the prevalence of resistance to NVP and AZT in mothers who had received the intensified regimen was measured. Specimens collected from mothers were genotyped by in-house PCR and sequencing. In specimens obtained within 60 days of delivery, acquired NVP resistance mutations were detected in 13 of 76 patients (17.1%, 95% confidence interval: 8.725.6%), which appears to be lowerthan in studies with sd NVP alone (37.5%, 95% confidence interval: 23.0-50.6%). J. Med. Virol. 80:942-946, 2008. © 2008 Wiley-Liss, Inc.

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