Treatment Of Acquired Immunodeficiency Syndrome Research Articles

Bienestar biopsicosocial en el plan de cuidados de enfermería al paciente adulto con VIH/SIDA

RESUMEN: 
 El Síndrome de Inmunodeficiencia adquirida (SIDA) se asocia a una serie de infecciones y determinadas neoplasias en estadío avanzado de la enfermedad, afectando la calidad de vida de quien lo padece. El presente reporte de caso trata de un paciente adulto de 43 años de edad postrado, con antecedentes de tratamiento por SIDA y tuberculosis (TBC) que se encuentra internado en un Hospital de Lima Norte por complicaciones con el desarrollo de su enfermedad. Ante la referida problemática, en el presente reporte de caso se planteó realizar las intervenciones de enfermería, centrándose en la mejora de la calidad de vida del paciente enfocado en el bienestar biopsicosocial, para lo cual se desarrollaron cuatro diagnósticos reales como prioridad. El plan de cuidados se ejecutó durante dos semanas, empleando la valoración de los 13 dominios de la Taxonomía II de NANDA-I, según aspectos positivos y negativos y la Taxonomía y clasificación de los diagnósticos, intervenciones y resultados de enfermería: Interventions Classification (NIC) y Nursing Outcomes Classification (NOC) II. Mediante las intervenciones se consiguió mejorar los aspectos negativos priorizados como diagnósticos: “Desequilibrio nutricional: Ingesta inferior a las necesidades corporales”, “Ansiedad”, “Desesperanza”, y “Baja autoestima situacional”, de la misma manera se logró mejorar la calidad de vida del paciente con el fomento de su bienestar, y satisfacción en este estadio de la enfermedad.

The HIV oligonucleotide database (HIVoligoDB).

The human immunodeficiency virus (HIV) is associated with one of the most widespread infectious disease, the acquired immunodeficiency syndrome (AIDS). The development of antiretroviral drugs and methods for virus detection requires a comprehensive analysis of the HIV genomic diversity, particularly in the binding sites of oligonucleotides. Here, we describe a versatile online database (HIVoligoDB) with oligonucleotides selected for the diagnosis of HIV and treatment of AIDS. Currently, the database provides an interface for visualization, analysis and download of 380 HIV-1 and 65 HIV-2 oligonucleotides annotated according to curated reference genomes. The database also allows the selection of the most conserved HIV genomic regions for the development of molecular diagnostic assays and sequence-based candidate therapeutics. Database URL: http://portugene.com/HIVoligoDB

CD4细胞检测在艾滋病诊疗中的意义

艾滋病是由HIV病毒感染机体CD4细胞后，损伤患者的免疫系统所引发的一种疾病。艾滋病具有传染性强、危害大、不可治愈的特点，给患者的家庭和社会都造成极大的负担。及早的发现病情，并积极的接受治疗可显著提升病人生活质量，降低传染风险。艾滋病的病程与患者的CD4阳性T细胞数量紧密相连，所以监测CD4细胞对于用药指导和药效评价都具有重大意义。 AIDS (acquired immunodeficiency syndrome) is caused by the invasion of HIV viruses and resultant damages to the immune-system. AIDS is a disease characterized by high infectivity, severe harm. So far, there is no cure for AIDS. Thus, it brings great burden to patients’ families and the society. Early detection and treatment of AIDS can significantly improve the quality of patients’ life and reduce the risk of disease expansion. The disease course of AIDS is closely linked with the number of CD4 positive T cells in the peripheral blood. Thus, monitoring the number of CD4 cells is of great significance for the guidance of drug use and the evaluation of drug efficacy.

In-silico Studies Show Potent Inhibition of HIV-1 Reverse Transcriptase Activity by a Herbal Drug.

Acquired immunodeficiency syndrome (AIDS) is a life threatening disease of the human immune system caused by human immunodeficiency virus (HIV). Effective inhibition of reverse transcriptase activity is a prominent, clinically viable approach for the treatment of AIDS. Few non-nucleoside reverse transcriptase inhibitors (NNRTIs) have been approved by the United States Food and Drug Administration (US FDA) as drugs for AIDS. In order to enhance therapeutic options against AIDS we examined novel herbal compounds of 4-thiazolidinone and its derivatives that are known to have remarkable antiviral potency. Our molecular docking and simulation experiments have identified one such herbal molecule known as (5E)-3-(2-aminoethyl)-5-benzylidene-1, 3-thiazolidine-2,4-dione that may bind HIV-1RT with high affinity to cause noncompetitive inhibition. Results are also compared with other US FDA approved drugs. Long de novo simulations and docking study suggest that the ligand (5E)-3-(2-aminoethyl)-5-benzylidene-1, 3-thiazolidine-2,4-dione (CID: 1656714) has strong binding interactions with Asp113, Asp110, Asp185 and Asp186 amino acids, all of which belong to one or the other catalytic pockets of HIV-1RT. It is expected that these interactions could be critical in the inhibitory activity of the HIV-1RT. Therefore, this study provides an evidence for consideration of (5E)-3-(2-aminoethyl)-5-benzylidene-1, 3-thiazolidine-2,4-dione as a valuable natural molecule in the treatment and prevention of HIV-associated disorders.

Computational prediction of anti HIV-1 peptides and in vitro evaluation of anti HIV-1 activity of HIV-1 P24-derived peptides.

The world is entering the third decade of the acquired immunodeficiency syndrome (AIDS) pandemic. The primary cause of the disease has known to be human immunodeficiency virus type I (HIV-1). Recently, peptides are shown to have high potency as drugs in the treatment of AIDS. Therefore, in the present study, we have developed a method to predict anti-HIV-1 peptides using support vector machine (SVM) as a powerful machine learning algorithm. Peptide descriptors were represented based on the concept of Chou's pseudo-amino acid composition (PseAAC). HIV-1 P24-derived peptides were examined to predict anti-HIV-1 activity among them. The efficacy of the prediction was then validated in vitro. The mutagenic effect of validated anti-HIV-1 peptides was further investigated by the Ames test. Computational classification using SVM showed the accuracy and sensitivity of 96.76% and 98.1%, respectively. Based on SVM classification algorithm, 3 out of 22 P24-derived peptides were predicted to be anti-HIV-1, while the rest were estimated to be inactive. HIV-1 replication was inhibited by the three predicted anti-HIV-1 peptides as revealed in vitro, while the results of the same test on two of non-anti-HIV-1 peptides showed complete inactivity. The three anti-HIV-1 peptides were shown to be not mutagenic because of the Ames test results. These data suggest that the proposed computational method is highly efficient for predicting the anti-HIV-1 activity of any unknown peptide having only its amino acid sequence. Moreover, further experimental studies can be performed on the mentioned peptides, which may lead to new anti-HIV-1 peptide therapeutics candidates.

A novel vaginal drug delivery system: anti-HIV bioadhesive film containing abacavir

Women are very much susceptible for acquired immunodeficiency syndrome (AIDS) and other sexually transmitted diseases (STDs), mainly due to unprotected heterosexual vaginal intercourse and for some other social and economical disadvantages. Our aim was to formulate and optimize vaginal film of abacavir, a potent nucleoside reverse transcriptase inhibitor, for the treatment of AIDS and HIV. Abacavir films were prepared by solvent evaporation method using sodium alginate (Na-alginate) as the main polymer, Hydroxypropyl Methylcellulose E 15 (HPMC E 15) as the copolymer and glycerol as a humectant. Abacavir sulphate (ABC) was used here as a drug. Films were optimized for various physicochemical parameters such as tensile strength, % elongation at break, swelling capacity, drug content (mg/cm(2)), thickness, folding endurance, bioadhesion, pH, moisture content and SEM. Drug polymer interaction was studied by FTIR Spectra. The drug release study was accomplished in dissolution apparatus. In vivo study was also carried out. This newly formed film was one kind of sustain release type and can be considered as a novel drug carrier system for the treatment of AIDS and other STDs. It was suitable for local as well as systemic effect. The films showed good physicochemical property with good aesthetic appeal.

A Mathematical Study of Combined Use of Anti-HIV Drugs and a Mutagen

The multidrug therapy for acquired immunodeficiency syndrome (AIDS) is efficacious in suppressing viral load, but it is an inappropriate treatment for AIDS patients suffering from side effects of anti-human immunodeficiency virus (HIV) drugs or who have developed resistance against these drugs. To cure these patients, alternative AIDS therapy is necessary. In a previous study 1, we discussed the availability of an alternative AIDS treatment that plunges viral activities into chaos by inducing excessive mutations by mutagenic activity in the HIV RNA genome and established a theoretical basis for its successful use in treatment. However concurrently mathematical analyses revealed treatment is only successful when the virulence of a virus was relatively low. In this study, we develop a new treatment to tackle HIV that has high virus virulence by examining the combined effects of a mutagenic agent and existing anti-HIV drugs. The drugs used include a reverse transcriptase inhibitor and a protease inhibitor. We prove that a therapy combining drug treatments with a mutagen is superior for its capacity to handle HIV with high virulence and its shorter treatment duration.

Treatment of acquired immunodeficiency syndrome with chinese medicine in China: Opportunity, advancement and challenges

Chinese medicine (CM) has been used in the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) for 30 years and the demonstrated therapeutic effects of CM, such as reducing plasma HIV viral load, increasing CD4(+)T cell counts, promoting immunity reconstitution, ameliorating symptoms and signs, improving the health related quality of life (HRQOL) and counteracting against the effects of anti-retroviral drugs, were summarized and reviewed in this article. The authors point out that it had been a good opportunity to use CM for the treatment of HIV infection and AIDS in the past and also there are huge challenges ahead for CM research and clinicians to discover more effective CM and its underlying mechanisms for treatment of AIDS.

Survival rate of AIDS disease and mortality in HIV-infected patients in Hamadan, Iran: a registry-based retrospective cohort study (1997–2011)

There remains a need to better understand the prognostic factors affecting the long-term survival in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), particularly in developing countries. We extracted data from 585 patients' medical records available at the triangular clinics for behavioural diseases. The outcomes of interest were the survival rates of progression to AIDS and death in HIV-positive subjects. The effect of several prognostic factors on survival time was investigated. One-year, five-year and 10-year survival rates from time of HIV diagnosis to AIDS were 89%, 69% and 30%, respectively. One-year and five-year survival rates from AIDS to death were 76% and 46%, respectively. One-year, five-year and 10-year survival rate from HIV diagnosis to death were 87%, 67% and 40%, respectively. Hazard ratio of progression to AIDS in HIV-positive subjects who were co-infected with tuberculosis was 4.50 (p < 0.001). Hazard ratio of death from AIDS-related causes was 4.77 in patients who did not receive highly active antiretroviral therapy compared to those who did (p < 0.001). Co-infection with tuberculosis was one of the most important prognostic factors of progression to AIDS and antiretroviral treatment was found to be an effective measure in suppressing HIV viral replication and improving the survival of patients living with HIV.

Vertical funding, non-governmental organizations, and health system strengthening: perspectives of public sector health workers in Mozambique

BackgroundIn the rapid scale-up of human immunodeficiency virus (HIV) care and acquired immunodeficiency syndrome (AIDS) treatment, many donors have chosen to channel their funds to non-governmental organizations and other private partners rather than public sector systems. This approach has reinforced a private sector, vertical approach to addressing the HIV epidemic. As progress on stemming the epidemic has stalled in some areas, there is a growing recognition that overall health system strengthening, including health workforce development, will be essential to meet AIDS treatment goals. Mozambique has experienced an especially dramatic increase in disease-specific support over the last eight years. We explored the perspectives and experiences of key Mozambican public sector health managers who coordinate, implement, and manage the myriad donor-driven projects and agencies.MethodsOver a four-month period, we conducted 41 individual qualitative interviews with key Ministry workers at three levels in the Mozambique national health system, using open-ended semi-structured interview guides. We also reviewed planning documents.ResultsAll respondents emphasized the value and importance of international aid and vertical funding to the health sector and each highlighted program successes that were made possible by recent increased aid flows. However, three serious concerns emerged: 1) difficulties coordinating external resources and challenges to local control over the use of resources channeled to international private organizations; 2) inequalities created within the health system produced by vertical funds channeled to specific services while other sectors remain under-resourced; and 3) the exodus of health workers from the public sector health system provoked by large disparities in salaries and work.ConclusionsThe Ministry of Health attempted to coordinate aid by implementing a “sector-wide approach” to bring the partners together in setting priorities, harmonizing planning, and coordinating support. Only 14% of overall health sector funding was channeled through this coordinating process by 2008, however. The vertical approach starved the Ministry of support for its administrative functions. The exodus of health workers from the public sector to international and private organizations emerged as the issue of greatest concern to the managers and health workers interviewed. Few studies have addressed the growing phenomenon of “internal brain drain” in Africa which proved to be of greater concern to Mozambique’s health managers.

Dor e analgesia em pacientes com síndrome da imunodeficiência adquirida

JUSTIFICATIVA E OBJETIVOS: Em pacientes com sindrome da imunodeficiencia adquirida (SIDA), o subdiagnostico e o subtratamento da dor sao alarmantes e poucos estudos analisam esse tema, bem como os registros de sua ocorrencia. O objetivo deste estudo foi analisar registros sobre dor e analgesia em prontuarios de pacientes com SIDA internados. METODO: Pesquisa documental, com analise de 63 prontuarios, realizado em hospital de referencia no tratamento da SIDA no Ceara, em 2010. Utilizou-se check-list para obtencao de dados e os resultados foram apresentados em tabelas com frequencias relativo/absoluta. RESULTADOS: Encontrou-se registro de dor na maioria dos prontuarios (90,5%), especificando localizacao (90,5%), fatores de melhora/piora (55,6%), intensidade (39,7%), frequencia (25,4%), entre outros aspectos. Foram responsaveis pelos registros medicos (94,7%), enfermeiros (87,8%) e fisioterapeutas (12,2%). Quanto a localizacao, prevaleceu cefaleia (50,9%), dor abdominal (52,6%), toracica (33,3%), membros inferiores (24,6%) e lombalgia (29,8%). Quanto a intensidade, dor forte (56%), leve (28%) e moderada (16%). Quanto a duracao, dor continua (62,5%) e intermitente (37,5%). Nas prescricoes farmacologicas, predominou anti-inflamatorio nao esteroide (66,7%), seguido de analgesicos simples (44,4%) e adjuvantes (41,3%). Medidas nao farmacologicas foram prescritas em apenas 11% dos prontuarios. CONCLUSAO: E necessaria a atencao dos profissionais para o registro de informacoes detalhadas das queixas algicas dos pacientes com SIDA, com a adocao de instrumentos adequados para a avaliacao e registro dos dados avaliados, para melhorar a assistencia e o controle da dor que incide na maioria desses pacientes.

Herbal compatibility of Traditional Chinese Medical formulas for acquired immunodeficiency syndrome

ObjectiveBecause herbal compatibility is one of the most important reasons why Traditional Chinese Medcine (TCM) formulas are effective for acquired immunodeficiency syndrome (AIDS), our study aimed to determine the compatibility of herbs based on published AIDS clinical research in Chinese periodicals. To achieve this aim, we designed a new data-mining algorithm according to TCM data characteristics. MethodsWe found 25 clinical AIDS studies, all using Chinese herbs for treatment, in the Traditional Chinese Medicine Database System, and information on diagnosis and treatment was extracted. To find out herbal compatibility, especially the formulae for herbal combinations, we proposed an improved association rule algorithm based on the frequency of combinations. In this algorithm, all the compatibility relationships were displayed in a tree structure, by which the relationship between formulas and their derivation could be clearly inferred. ResultsData analysis showed that approximately 100 herbs have been used for treating AIDS. Based on the whole herb compatibility tree, we calculated a basic formula for AIDS: Huang Qi combined with Ren Shen, Fu Ling, Bai Zhu, Bai Zhu, Dang Gui, and Bai Shao. This formula, deriving from most of clinical prescriptions, and was chosed by most of clinicians for AIDS treatment. From data mining we found that Qi replenishment and detoxification were the main treatment principles, which coincided with the AIDS pathological mechanism in which immune function is destroyed by human immunodeficiency virus (HIV). ConclusionsOur data-mining results suggest that the core TCM treatment of AIDS is replenishing Qi and detoxification, by which AIDS patients' immune system may be enhanced. Compatibility of Huang Qi with some frequently-used herbs have shown real efficacy in clinical practice, which warrants pharmacological research in the future.

Awareness on HIV / Aids of the Fisher Folk Villages of Coastal Andhra Pradesh

This study examines whether traditional health beliefs and practices of fisher folk villages of north costal Andhra Pradesh reported in the literature were consistent with those of a target population of low-income women in Srikakulam, Vizianagaram and Visakhapatnam and describes how these traditional classifications of illness and healing practices were related to their understanding of acquired immunodeficiency syndrome (AIDS). A qualitative approach was used to gather the data in unstructured interviews. Content analysis was used to classify data. Sources of illness and remedies identified by the patients were divided into two categories: natural and supernatural. Natural sources included cold, impurities, diet, weakness, lack of moderation, and stress. Supernatural sources included illnesses allowed by God, witchcraft, and evil influences. Remedies included antidotes, food, medicines, prayer, and healing. Analysis of the relationship of AIDS to traditional beliefs revealed that AIDS had been integrated into the traditional conceptualization of illness, health practices, and healing, and was attributed to both natural and supernatural causes. Prevention, prayer, and spiritual healing were recommended as remedies. Implications were that AIDS education, prevention, and treatment programs be within the context of the traditional belief system.

Updates on the prevention and treatment of AIDS

June 5, 2011, marked the 30th year since the first cases of acquired immunodeficiency syndrome (AIDS) were reported. From just five cases in the initial publication, AIDS has grown into a global pandemic that has resulted in the deaths of more than 33 million people around the world. There have been many successful stories of human immunodeficiency virus (HIV) treatment and prevention during the past 3 decades of the AIDS epidemic. Among them, HIV chemotherapy has been a major medical accomplishment and has dramatically reduced the morbidity and mortality of those with access to care. The combination of prevention and treatment has substantially decreased the spread of the disease and dramatically increased life expectancy among treated patients. Ongoing studies on curing HIV infections are providing us with hopeful perspectives for eradicating this huge epidemic. We must attain the sustainability of economic resources in order to ensure the continuation of the advances that have been achieved and provide new perspectives on future challenges.

Potential of polymeric nanoparticles in AIDS treatment and prevention

Importance of the field: Acquired immunodeficiency syndrome (AIDS) remains one of the greatest challenges in public health. The AIDS virus is now responsible for > 2.5 million new infections worldwide each year. Despite significant advances in understanding the mechanism of viral infection and identifying effective treatment approaches, the search for optimum treatment strategies for AIDS remains a major challenge. Recent advances in the field of drug delivery have provided evidence that engineered nanosystems may contribute to the enhancement of current antiretroviral therapy.Areas covered in this review: This review describes the potential of polymeric nanoparticle-based drug delivery systems in the future treatment of AIDS. Polymeric nanoparticles have been developed to improve physicochemical drug characteristics (by increasing drug solubility and stability), to achieve sustained drug release profile, to provide targeting to the cellular and anatomic human immunodeficiency virus (HIV) latent reservoirs and to be applied as an adjuvant in anti-HIV vaccine formulations.What the reader will gain: The insight that will be gained is knowledge about the progress in the development of polymeric nanoparticle-based drug delivery systems for antiretroviral drugs as alternative for AIDS treatment and prevention.Take home message: The advances in the field of targeted drug delivery can result in more efficient strategies for AIDS treatment and prevention.

Effects of Plant Extracts on HIV-1 Protease

Acquired immunodeficiency syndrome (AIDS) is one of the most important public health problems, affecting many people every day. This syndrome is caused by the human immunodeficiency virus (HIV) and the HIV-1 protease plays an essential role by promoting virus maturation and thus infecting new cells. The HIV-1 protease is one of the main targets for anti-HIV drug therapy. The present work is a literature survey of plant extracts whose activity has been studied on HIV-1 protease. Here we list 275 species of medicinal plants, distributed in 99 families, with their place of origin, part used, type of extract, concentration and activity. We aim with this work to provide data that could be used in the research and development of new therapeutic agents for AIDS treatment.

FORMULATION AND EVALUATION OF SUSTAINED RELEASE TABLETS CONTAINING ANTIOXIDANTS

Deficiency in nutrients especially antioxidants play an important role in the pathogenesis of acquired immuno-deficiency syndrome (AIDS). Antioxidants; vitamin A, vitamin C, vitamin E, zinc and selenium are available in market as capsules. The release rate is very fast followed by fast elimination. It is necessary to prolong the residence time of antioxidants. Sustained release tablet formulation was designed and evaluated on small scale and on large scale preparations. Low attention has been discuss the use of sustained release formula in treatment of AIDS. Sustained release tablet formulation was designed and evaluated on small scale and on large scale preparations. The formulated tablets contained beta-carotene, vitamin C, tocopherol acetate, selenium, yeast and zinc pidolate. Vitamin C was chosen as tracer for detection and evaluation of tablet dosage form. Vitamin C was found to be stable in 0.1 N HCl (pH 1.2) along 8 hrs at 37°C. The formulated tablets passed the pharmacopeial requirements for all tablet tests. The formulated tablets showed sustained release characteristics of vitamin C as a tracer, within 8 hrs.

HIGH RATE OF MUTATION K103N CAUSING RESISTANCE TO NEVIRAPINE IN INDIAN CHILDREN WITH ACQUIRED IMMUNODEFICIENCY SYNDROME

In north India the number of paediatric cases with acquired immunodeficiency syndrome (AIDS) is on the rise. Most drug combinations used for treatment of AIDS incorporate nevirapine, resistance to which develops very fast if given singly or because of unplanned interruptions. This paper investigates presence of mutations at codon 103 and codon 215 of the HIV pol gene causing resistance to nevirapine and zidovudine (AZT) respectively in 25 children with AIDS. Mutations T215Y and K103N were detected by a nested cum amplification refractory mutation system polymerase chain reaction (ARMS PCR) and the results were confirmed by direct sequencing in five randomly selected cases. Nineteen patients had received nevirapine containing regimen and six were drug naive. Mutation K103N was observed in 56% (14/25) of the children while mutation T215Y was found in none. Two of the six drug naïve children also showed K103N mutation. Thus, Indian children drug naïve or treated with nevirapine containing regimens show a high rate of mutation conferring resistance to nevirapine which calls for a judicious use of nevirapine both in antenatal and postnatal setting.

難治性咽頭潰瘍で初発したＨＩＶ感染症

Human immunodeficiency virus (HIV) infection induces acquired immunodeficiency syndrome (AIDS) as a consequence of collapsed immunity ten or more years after infection. At present, the number of HIV-infected patients is supposed to be about 39, 400, 000 worldwide. In Japan, the total number of HIV and AIDS patients may be over 10, 000 and the most frequent cause is homosexual intercourse. We report on a patient with intractable pharyngeal ulceration who consulted our clinic for pharyngeal and swallowing pain and was finally diagnosed as HIV-positive.Case A: 36-year-old man. His complaint started at the beginning of June 2006. He was treated for pharyngitis at a local clinic of internal medicine, but there was no response. Therefore, he was referred to our clinic on July 24th. An oro-pharyngeal examination demonstrated an ulcer and white furred region at the right oropharynx and left aryepiglottic fold. A cuture of hemanalysis demonstrated panhematopenia and the white furred region showed indigenous bacterial flora. Swallowing pain increased and he was admitted to our hospital on August 24th. Since he was noncompliant with antiseptic medication at the outpatient clinic, we suspected the possibility of a sexually transmitted infection at admission. It was determined that he was homosexual and HIV-positive. As a result of conservative therapy pharyngeal pain has diminished and the treatment of AIDS was started after referred to the general clinical department. We report the characteristics of HIV-positive induced oro-pharyngeal symptoms with a review of the literature.

High rate of mutation K103N causing resistance to nevirapine in Indian children with acquired immunodeficiency syndrome

In north India the number of paediatric cases with acquired immunodeficiency syndrome (AIDS) is on the rise. Most drug combinations used for treatment of AIDS incorporate nevirapine, resistance to which develops very fast if given singly or because of unplanned interruptions. This paper investigates presence of mutations at codon 103 and codon 215 of the HIV pol gene causing resistance to nevirapine and zidovudine (AZT) respectively in 25 children with AIDS. Mutations T215Y and K103N were detected by a nested cum amplification refractory mutation system polymerase chain reaction (ARMS PCR) and the results were confirmed by direct sequencing in five randomly selected cases. Nineteen patients had received nevirapine containing regimen and six were drug naive. Mutation K103N was observed in 56% (14/25) of the children while mutation T215Y was found in none. Two of the six drug naïve children also showed K103N mutation. Thus, Indian children drug naïve or treated with nevirapine containing regimens show a high rate of mutation conferring resistance to nevirapine which calls for a judicious use of nevirapine both in antenatal and postnatal setting.