单次奈韦拉平给药后母乳中奈韦拉平耐药性的出现和持续存在。
Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration.
机构信息
Department of Pathology, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21205, USA.
出版信息
AIDS. 2010 Feb 20;24(4):557-61. doi: 10.1097/QAD.0b013e3283346e60.
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.
目的
单剂量奈韦拉平（NVP）（sdNVP）可降低母婴垂直传播 HIV 的风险。我们评估了乌干达女性接受 sdNVP 暴露后血浆和母乳中 NVP 耐药的危险因素。
方法
使用罗氏 AMPLICOR HIV-1 Monitor Test Kit，版本 1.5 和 ViroSeq HIV-1 Genotyping System 对样本进行分析。通过液相色谱-串联质谱法测定 NVP 浓度。
结果
30 名妇女在接受 sdNVP 后 4 周获得了 HIV 基因型（血浆和母乳）（HIV 亚型：15A、1C、12D、两种重组）。在 30 个母乳样本中检测到 12 个（40%）NVP 耐药。母乳中检测到 NVP 耐药与血浆中 NVP 耐药之间存在无显著趋势（P = 0.06）。母乳中 HIV 耐药与母亲在接受 NVP 前的中位病毒载量或 CD4 细胞计数、4 周时母乳中的中位病毒载量、母乳中钠浓度大于 10mmol/L、HIV 亚型或母乳或血浆中 NVP 的浓度无关。
结论
在 sdNVP 暴露后 4 周，母乳中经常检测到 NVP 耐药。在这项研究中，我们无法确定与母乳中 NVP 耐药相关的特定因素。
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