HIV Drug Resistance in Mothers and Infants Following Use of Antiretrovirals to Prevent Mother-to-Child Transmission

被引:18
作者
Ton, Quy [1 ]
Frenkel, Lisa [1 ,2 ]
机构
[1] Univ Washington, Seattle, WA 98195 USA
[2] Seattle Childrens Res Inst, Seattle, WA 98101 USA
关键词
HIV; HIV drug-resistance; nevirapine; prevention of mother-to-child transmission of HIV; zidovudine; SINGLE-DOSE NEVIRAPINE; IMMUNODEFICIENCY-VIRUS TYPE-1; INFECTED PREGNANT-WOMEN; REVERSE-TRANSCRIPTASE; TRANSMITTED HIV; SUBTYPE-A; VERTICAL TRANSMISSION; BREAST-MILK; PERINATAL TRANSMISSION; ZIDOVUDINE RESISTANCE;
D O I
10.2174/1570162X11311020005
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
The purpose of this article is to review prominent studies on HIV drug-resistance in mothers and their infants after the use of antiretroviral drugs to prevent mother-to-child-transmission in resource-limited communities. The effects of drug-resistance on subsequent combination antiretroviral therapy are discussed, as are the probable mechanisms of acquisition and decay or persistence of drug-resistant mutants. Differences in the rates of HIV drug-resistance from interventions used to prevent mother-to-child-transmission in North America and Europe are contrasted to the simplified regimens used in resource-limited settings. Unresolved issues related to HIV drug-resistance are reviewed, including: whether maternal zidovudine monotherapy selects significant resistance; the clinical relevance of HIV drug-resistant variants selected by single-dose nevirapine that persist as minority viral variants and can affect the outcome of non-nucleoside reverse transcriptase inhibitor-based therapy; and the use of maternal combination antiretroviral therapy during breastfeeding. Finally, the current and upcoming strategies to reduce HIV drug-resistance related to use of antiretrovirals to prevent mother-to-child-transmission are discussed and contrasted with the challenges of financing and administering antiretrovirals to prevent mother-to-child-transmission in resource-limited communities.
引用
收藏
页码:126 / 136
页数:11
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