Prevalence of resistance to nevirapine in mothers and children after single-dose exposure to prevent vertical transmission of HIV-1: a meta-analysis†

Abstract

Single-dose NVP is widely used for PMTCT in resource-poor settings, but the burden of viral resistance is high in both women and children. It is substantially lower in studies providing additional postpartum antiretrovirals. The clinical implications of these findings should be further investigated.

Developmental delay in HIV-exposed infants in Harare, Zimbabwe

“…In the management of infants, utilising CNSpenetrating regimens are not always possible. Single-dose NVP (sd-NVP) is widely used in sub-Saharan Africa in the prophylactic treatment of infants in the management of PMTCT; however there is controversy over its use due to the emergence of NNRTI resistance mutations developing readily (Arrivé, et al, 2007;Kassaye, et al, 2007).…”

“…One study reports the prevalence of NVP resistance in children following single-dose administration as 52.6% (Arrivé, et al, 2007). However other studies report that this resistance disappears after time (Kassaye, et al, 2007).…”

Mortality and Clinical Outcomes in HIV-Infected Children on Antiretroviral Therapy in Malawi, Lesotho, and Swaziland

“…22,[32][33][34] Relatively small studies have documented the risk of development of nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance after failed single-dose nevirapine prophylaxis in HIV-infected infants, and a recent IeDEA-SA study demonstrated an increased probability of virologic failure after exposure to PMTCT regimens. [35][36][37][38] During the time of this study, Malawi and Swaziland used an NNRTI-based first-line ART regimen for all infants and children regardless of PMTCT exposure, whereas, starting in 2008, Lesotho implemented a policy of using a protease inhibitorbased regimen for children with a history of maternal or infant NNRTI exposure. Given the retrospective design of the study and lack of resistance testing, causality cannot be determined, but …”

Non-AIDS Morbidity among HIV Patients

“…Young children with HIV who are exposed to NNRTIs used for PMTCT may have demonstrable viral resistance (150), which compromises the response to NVP-containing first-line ART (151,152). For this reason, the 2010 WHO guidelines (105) recommended the use of LPV/r-based treatment in children younger than 24 months of age previously exposed to NNRTIs.…”