Development of Resistance After Administration of Single-Dose Nevirapine to Prevent Mother-To-Child Transmission of HIV

Abstract

In 2006, 530,000 children were newly infected with HIV, most of them by mother-to-child transmission (MTCT) in sub-Saharan Africa. Although single-dose nevirapine (sdNVP) given alone to the mother and the neonate to reduce MTCT rates is efficacious, simple to use and affordable, this regimen induces high rates of NVP viral resistance. The main factors associated with the occurrence of NVP resistance include: low CD4 count, high plasma viral load at delivery, timing of measurement, high NVP concentration, viral subtype C and no concomitant administration of other antiretrovirals. No impairment of the immunological or clinical response to NVP-based treatment or of the efficacy of sdNVP on pregnancies was demonstrated in women and children previously exposed to sdNVP. However, they may be less likely to have virological suppression unless maternal treatment is initiated at least 6 months after sdNVP exposure. Further research is needed to evaluate strategies to reduce or avoid such risk.