Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration

作者：Hudelson Sarah E; McConnell Michelle S; Bagenda Danstan; Piwowar Manning Estelle; Parsons Teresa L; Nolan Monica L; Bakaki Paul M; Thigpen Michael C; Mubiru Michael; Fowler Mary Glenn; Eshleman Susan H^*

来源：AIDS, 2010, 24(4): 557-561.

DOI：10.1097/QAD.0b013e3283346e60

• breast milk
• HIV-1
• nevirapine
• nevirapine resistance
• Uganda
• vertical transmission

Objective: Single-dose nevirapine (NVP) (sdNVP) can reduce the risk of HIV vertical transmission. We assessed risk factors for NVP resistance in plasma and breast milk from sdNVP-exposed Ugandan women.
Methods: Samples were analyzed using the Roche AMPLICOR HIV-1 Monitor Test Kit, version 1.5, and the ViroSeq HIV-1 Genotyping System. NVP concentrations were determined by liquid chromatography with tandem mass spectroscopy.
Results: HIV genotypes (plasma and breast milk) were obtained for 30 women 4 weeks after sdNVP (HIV subtypes: 15A, 1C, 12D, two recombinant). NVP resistance was detected in 12 (40%) of 30 breast milk samples. There was a nonsignificant trend between detection of NVP resistance in breast milk and plasma (P = 0.06). There was no association of HIV resistance in breast milk with median maternal pre-NVP viral load or CD4 cell count, median breast milk viral load at 4 weeks, breast milk sodium more than 10 mmol/l, HIV subtype, or concentration of NVP in breast milk or plasma.
Conclusion: NVP resistance was frequently detected in breast milk 4 weeks after sdNVP exposure. In this study, we were unable to identify specific factors associated with breast milk NVP resistance.

• 出版日期2010-2-20