Antiretroviral resistance and HIV vertical transmission

The author reviews the current and potential problem of antiviral resistance in the prevention of vertical transmission of human immunodeficiency virus (HIV) from mother to child. The paper addresses five questions: (i) How often does antiretroviral resistance occur? While this does not appear to be an important problem now, low levels of resistance are probably common, and resistance can be expected to increase in frequency; (ii) Does resistance influence the rate of vertical transmission? The answer is likely to be yes if the drug in question is used in an effort to prevent or reduce transmission; (iii) What are the consequences for the mother? These are certainly not good and might, if the drug in question is important for the mother's health, be bad; (iv) What are the consequences for the baby? The answer to this question is similar, with the additional concern that resistance might make preventive measures less effective and thus increase the chance of transmission: (v) What can be done about it? Combination treatment may be effective in minimizing the development of resistance. As with other antimicrobials, selective and rational use of drugs for specific purposes will minimize the problem. The conclusion of the discussion is that resistance is likely to emerge as an important problem over time and should be addressed in strategies for prevention.