Document Detail

Initiation of antiretroviral treatment in women after delivery can induce multiclass drug resistance in breastfeeding HIV-infected infants.
MedLine Citation:
PMID:  21460326     Owner:  NLM     Status:  MEDLINE    
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.
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:
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:
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:
Created Date:  2011-04-04     Completed Date:  2011-07-18     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1069-76     Citation Subset:  IM    
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
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MeSH Terms
Anti-HIV Agents / administration & dosage*
Antiretroviral Therapy, Highly Active / methods*
Breast Feeding*
Child, Preschool
Drug Resistance, Multiple, Viral*
HIV Infections / drug therapy*,  virology*
Infant, Newborn
Plasma / virology
Postpartum Period*
RNA, Viral / genetics,  isolation & purification
Grant Support
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
Reg. No./Substance:
0/Anti-HIV Agents; 0/RNA, Viral

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