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Drug-Resistant HIV Can Persist in Postpartum Period

Above baseline levels still present one year after nevirapine treatment

WEDNESDAY, April 26 (HealthDay News) -- Single-dose nevirapine (sdNVP) for the prevention of vertical HIV-1 transmission can give rise to nevirapine-resistant variants that persist for more than a year, according to a report published online April 25 in the Proceedings of the National Academy of Sciences Early Edition.

John Coffin, Ph.D., from the National Cancer Institute in Frederick, Md., and colleagues used sensitive allele-specific PCR genotyping to assess the extent of persistence and rates of decay of nevirapine-resistant HIV-1 variants that commonly emerge after sdNVP. Plasma samples from 22 HIV-1 subtype C-positive mothers were obtained at baseline and two, six and 12 months after receiving sdNVP.

Fifteen of the mothers had nevirapine-resistant mutations at two months, which diminished over time. However, at least 23 percent of mothers had above baseline levels of the resistant mutations after more than one year.

"These findings highlight the urgent need for studies assessing the impact of sdNVP on the efficacy of subsequent antiretroviral therapy containing NVP or other nonnucleoside reverse transcriptase inhibitors," the authors conclude. "Additional studies are needed to assess the clinical significance of NVP-resistant variants, particularly in relation to subsequent treatment with antiretroviral therapy and subsequent pregnancies."

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