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Selection of HIV Resistance Associated With Antiretroviral Therapy Initiated Due to Pregnancy and Suspended Postpartum

Ellis, Giovanina M. BS*; Huang, Sharon MS; Hitti, Jane MD, MPH; Frenkel, Lisa M. MD*,‡for the P1022 Study Team

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2011 - Volume 58 - Issue 3 - p 241–247
doi: 10.1097/QAI.0b013e31822b4edc
Basic and Translational Science

Objective Compare the risk of HIV drug resistance in women stopping suppressive nelfinavir (NFV)-based or Nevirapine (NVP)-based antiretroviral therapy (ART) after pregnancy.

Methods Specimens collected after stopping ART were tested for drug resistance by an oligonucleotide ligation assay and consensus sequencing. When postpartum drug resistance was detected, specimens obtained at study entry and during ART were evaluated.

Results Sixteen of 38 women with ART-induced suppression of viral replication suspended ART postpartum. Resistance mutations were detected in 75% who stopped NFV-ART and in 50% who stopped NVP-ART. M184V, associated with Lamivudine resistance, was more frequent among those randomized to NFV-ART compared with NVP-ART (6 of 8 versus 1 of 8; P = 0.04), and nonnucleoside reverse transcriptase inhibitor resistance was detected in 4 of 8 stopping NVP-ART.

Conclusions HIV drug resistance was frequently observed among women who stopped suppressive NVP-ART or NFV-ART postpartum. This suggests that NFV-ART may have suboptimal potency, that staggering discontinuation of NVP-ART may be warranted, and/or ART adherence may be lax in women who choose to stop ART postpartum.

*Center for Childhood Infections and Prematurity Research, Seattle Children's Research Institute, Seattle, WA

Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA

Departments of Laboratory Medicine, Obstetrics and Gynecology, and Pediatrics, University of Washington, Seattle, WA.

Supported by a Developmental Virology Laboratory award from the International Maternal Pediatric Adolescent AIDS Clinical Trials Group. Overall support of International Maternal Pediatric Adolescent AIDS Clinical Trials Group was provided by the National Institute of Allergy and Infectious Diseases (U01 AI068632), the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institutes of Mental Health (AI068632). This work was also supported by the Statistical and Data Analysis Center at the Harvard School of Public Health, under the National Institute of Allergy and Infectious Diseases cooperative agreement #5 U01 AI41110 with the Pediatric AIDS Clinical Trials Group and #1 U01 AI068616 with the International Maternal Pediatric Adolescent AIDS Clinical Trials Group. Support of the sites was provided by the National Institute of Allergy and Infectious Diseases and the National Institute of Child Health and Human Development International and Domestic Pediatric and Maternal HIV Clinical Trials Network funded by National Institute of Child Health and Human Development (contract number N01-DK-9-001/HHSN267200800001C).

Poster presented at the 16th Conference on Retroviruses and Opportunistic Infections, February 10, 2009, Montreal, QC.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no conflicts of interest to disclose.

Correspondence to: Lisa M. Frenkel, MD, Seattle Children's Hospital and Research Institute, 1900, 9th Avenue, Seattle, WA 98101 (e-mail: lfrenkel@u.washington.edu).

Received January 28, 2011

Accepted June 15, 2011

© 2011 Lippincott Williams & Wilkins, Inc.