| Initiation of antiretroviral treatment in women after delivery can induce multiclass drug resistance in breastfeeding HIV-infected infants. | |
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MedLine Citation:
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PMID: 21460326 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The World Health Organization currently recommends initiation of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-infected lactating women with CD4+ cell counts <350 cells/μL or stage 3 or 4 disease. We analyzed antiretroviral drug resistance in HIV-infected infants in the Post Exposure Prophylaxis of Infants trial whose mothers initiated HAART postpartum (with a regimen of nevirapine [NVP], stavudine, and lamivudine). Infants in the trial received single-dose NVP and a week of zidovudine (ZDV) at birth; some infants also received extended daily NVP prophylaxis, with or without extended ZDV prophylaxis. METHODS: We analyzed drug resistance in plasma samples collected from all HIV-infected infants whose mothers started HAART in the first postpartum year. Resistance testing was performed using the first plasma sample collected within 6 months after maternal HAART initiation. Categorical variables were compared by exact or trend tests; continuous variables were compared using rank-sum tests. RESULTS: Multiclass resistance (MCR) was detected in HIV from 11 (29.7%) of 37 infants. Infants were more likely to develop MCR infection if their mothers initiated HAART earlier in the postpartum period (by 14 weeks vs after 14 weeks and up to 6 months vs after 6 months, P = .0009), or if the mother was exclusively breastfeeding at the time of HAART initiation (exclusive breastfeeding vs mixed feeding vs no breastfeeding, P = .003). CONCLUSIONS: Postpartum maternal HAART initiation was associated with acquisition of MCR in HIV-infected breastfeeding infants. The risk was higher among infants whose mothers initiated HAART closer to the time of delivery or were still exclusively breastfeeding when they first reported HAART use. |
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Authors:
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Jessica Fogel; Qing Li; Taha E Taha; Donald R Hoover; Newton I Kumwenda; Lynne M Mofenson; Johnstone J Kumwenda; Mary Glenn Fowler; Michael C Thigpen; Susan H Eshleman |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, N.I.H., Intramural; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 52 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2011 Apr |
Date Detail:
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Created Date: 2011-04-04 Completed Date: 2011-07-18 Revised Date: 2012-09-18 |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 1069-76 Citation Subset: IM |
Affiliation:
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Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Anti-HIV Agents
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administration & dosage* Antiretroviral Therapy, Highly Active / methods* Breast Feeding* Child, Preschool Drug Resistance, Multiple, Viral* Female Genotype HIV Infections / drug therapy*, virology* Humans Infant Infant, Newborn Plasma / virology Postpartum Period* RNA, Viral / genetics, isolation & purification |
| Grant Support | |
ID/Acronym/Agency:
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R01 HD050180/HD/NICHD NIH HHS; R03 HD061299/HD/NICHD NIH HHS; U01 AI068613/AI/NIAID NIH HHS; U01 AI068613-05/AI/NIAID NIH HHS; U01 AI068633/AI/NIAID NIH HHS; U50/CCU022061//PHS HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents; 0/RNA, Viral |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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