Tuberculosis Research Centre (ICMR), Chennai, India.
Indian J Med Res. 2010 Nov;132(5):509-12.
BACKGROUND & OBJECTIVES: Resistance to nevirapine (NVP) has been described with single dose preventive regimens in other populations. Our aim was to study the pattern and prevalence of HIV drug resistance (DR) at baseline (during pregnancy) and after delivery among antenatal women exposed to single dose NVP for prevention of parent to child transmission (PPTCT).
HIV-infected, ART-naive primigravidae between 18-25 years of age, attending government antenatal clinics in Chennai, Vellore or Madurai were recruited. Drug resistance testing was carried out during pregnancy and after Sd-NVP treatment (one month after delivery) by Viroseq sequencing. HIV-1 testing by DNA PCR was done in newborns at 30 days.
Thirty one women were enrolled but only twenty six plasma specimens were analyzable (24 paired and two postnatal only). No major mutations were observed in any drug class at baseline though many polymorphisms were observed in both the reverse transcriptase and protease genes. Mutations to non-nucleoside reverse transcriptase inhibitors (NNRTI) were observed post-delivery in 33 per cent of women who were treated with Sd-NVP. None of the infants were HIV-positive.
INTERPRETATION & CONCLUSIONS: Among pregnant ART-naive women, baseline HIV drug resistance was not observed. A high rate of development of NNRTI class resistance among women treated with single-dose NVP was observed. Our results emphasize the need to implement more effective PPTCT regimens, minimizing emergence of drug resistance and thereby preserving long-term treatment options for HIV-infected women in India.
在其他人群中，已经描述了单剂量预防方案对奈韦拉平（NVP）的耐药性。我们的目的是研究在接受单剂量 NVP 预防母婴传播（PPTCT）的产前妇女中，基线时（怀孕期间）和分娩后 HIV 耐药性（DR）的模式和流行率。
在钦奈、维洛尔或马杜赖的政府产前诊所招募 18-25 岁、初次接受 ART 治疗的 HIV 感染、ART 初治的初产妇。在怀孕期间和 Sd-NVP 治疗后（分娩后一个月）通过 Viroseq 测序进行耐药性检测。在新生儿出生后 30 天通过 DNA PCR 进行 HIV-1 检测。
共招募了 31 名妇女，但只有 26 份血浆标本可分析（24 对和 2 份仅产后）。尽管在逆转录酶和蛋白酶基因中均观察到许多多态性，但在基线时未观察到任何药物类别中的主要突变。在接受 Sd-NVP 治疗的妇女中，33%的妇女在分娩后出现非核苷类逆转录酶抑制剂（NNRTI）耐药突变。没有婴儿 HIV 阳性。
在接受 ART 初治的孕妇中，未观察到基线 HIV 耐药性。在接受单剂量 NVP 治疗的妇女中，观察到 NNRTI 耐药率较高。我们的研究结果强调需要实施更有效的 PPTCT 方案，最大程度地减少耐药性的出现，从而为印度的 HIV 感染妇女保留长期治疗选择。
