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Abstract
Low emergence of nevirapine (NVP) and lamivudine (3TC) resistance after post-partum interruption of a triple drug regimen for prevention of HIV mother to child transmission (MTCT)
Pérez H.1, Vignoles M.2, Laufer N.1, Gómez A.2, Coll P.1, Lattner J.1, Rolón M.J.1, Salomón H.2, Cahn P.1
Objectives: Emergence of resistance to NVP may be a consequence of monotherapy to prevent HIV MTCT.
Aim of study: to evaluate the emergence of resistant strains to NVP and 3TC after discontinuation of antiretroviral therapy (ART) with 3TC/zidovudine (ZDV)/NVP.
Methods: Twenty pregnant women (ART naïve or pre-exposed only to ZDV) in whom 3TC/ZDV/NVP was prescribed for MTCT prophylaxis, were studied. They received ART for median of 4 months with median viral load (VL) at labor: <50 copies/ml (<50-108 copies/ml). Samples were collected between 1 and 15 months (median: 3 months) after ART interruption. Standard genotypic sequencing and sequence-selective real-time PCR (SPCR) were assayed. SPCR permitted quantification of either all viral sequences or those containing K103N (AAC, AAT), Y181C (TGT) and M184V (GTG) mutations.
Results: We have previously reported no selection of K103N AAC mutation in these patients (13th CROI, Denver, Colorado). No mutations associated with resistance to 3TC/NVP were found by standard sequencing. The lowest detection limit of SPCR for each mutation was 0.5% for Y181C and 0.1% for K103N and M184V. For K103N, 5 patients (25%) had <0.1% of virus with AAT mutation. For Y181C mutation, two patients had <0.5% of virus with TGT codon change. For M184V mutation, 1 patient had 6.21% of virus with GTG mutation, 6 (30%) had <0.1% and 7 (35%) had between 0.2 and 0.88% of mutated viruses. Two patients received 3TC/ZDV/NVP during a second pregnancy and 1 started 3TC/ZDV/NVP due to immune deterioration. When reexposed to 3TC/ZDV/NVP, HIV VL <50 copies/ml was achieved. No perinatal transmission occurred in any of the 22 birth.
Conclusions: NVP associated with 2 NRTIs as a regimen to prevent MTCT carries a low risk of selection of NVP and 3TC resistant strains, even when studied with real time PCR techniques, and seems not to jeopardize future treatment options with the same drugs.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
TUPEC028
Suggested Citation
"PérezH., et al.
Low emergence of nevirapine (NVP) and lamivudine (3TC) resistance after post-partum interruption of a triple drug regimen for prevention of HIV mother to child transmission (MTCT).
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
TUPEC028"
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