Han J, Wang L, Jiang Y, Zhang Q, Fang L, Yao J, Wang Q
National AIDS Reference Laboratory, National Center for AIDS/STD Control and Prevention, China Center for Disease Control and Prevention, 27 Nanwei Road, Beijing 100050, People's Republic of China.
Int J STD AIDS. 2009 Apr;20(4):249-54. doi: 10.1258/ijsa.2008.008480.
The objective of this study was to assess the resistance baseline in HIV-1-infected pregnant women in China and the emergence of drug resistance (DR) among them and their infants after receiving single-dose nevirapine (sdNVP) or zidovudine plus sdNVP (ZDV-sdNVP) for the prevention of mother-to-child transmission (PMTCT). The prospective study followed 62 drug-naïve HIV-1-infected mothers and their infants who received sdNVP for PMTCT and 18 who received ZDV-sdNVP. Primary DR was detected in 8.8% (7/80) of pregnant women at baseline. Two (2.5%) women had mutations associated with nucleoside reverse transcriptase inhibitors (NRTI). Six (7.5%) women harboured mutations associated with non-nucleoside reverse transcriptase inhibitors (NNRTI). No protease inhibitor (PI) DR was detected. The DR rates in infected mothers selected by sdNVP and ZDV-sdNVP regimen were 16.3% and 0%, respectively. Women with the emergence of DR after sdNVP had lower CD4 cell counts at delivery than women without DR after sdNVP (178 vs.364 cells/mm(3), P < 0.05). The vertical transmission rate in women with baseline resistance was similar to that in women without baseline resistance (1/7 vs. 3/73, P > 0.05). The study indicates that NVP resistance after sdNVP was associated with CD4 cell count at delivery. ZDV-sdNVP regimen was of more significance in the prevention of the emergence of NNRTI-related DR than sdNVP.
本研究的目的是评估中国HIV-1感染孕妇的耐药基线，以及她们及其婴儿在接受单剂量奈韦拉平（sdNVP）或齐多夫定加sdNVP（ZDV-sdNVP）以预防母婴传播（PMTCT）后耐药性（DR）的出现情况。这项前瞻性研究追踪了62名未接受过抗逆转录病毒治疗的HIV-1感染母亲及其接受sdNVP进行PMTCT的婴儿，以及18名接受ZDV-sdNVP的母亲及其婴儿。基线时，8.8%（7/80）的孕妇检测到原发性DR。两名（2.5%）女性有与核苷类逆转录酶抑制剂（NRTI）相关的突变。六名（7.5%）女性携带与非核苷类逆转录酶抑制剂（NNRTI）相关的突变。未检测到蛋白酶抑制剂（PI）耐药。接受sdNVP和ZDV-sdNVP方案的感染母亲的耐药率分别为16.3%和0%。接受sdNVP后出现耐药的女性分娩时的CD4细胞计数低于接受sdNVP后未出现耐药的女性（178对364个细胞/mm³，P<0.05）。基线耐药女性的垂直传播率与无基线耐药女性相似（1/7对3/73，P>0.05）。该研究表明，sdNVP后的NVP耐药与分娩时的CD4细胞计数有关。ZDV-sdNVP方案在预防NNRTI相关DR的出现方面比sdNVP更具意义。
