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n Southern African Journal of HIV Medicine - MTCT regimen choice, drug resistance and the treatment of HIV-1-infected children : MTCT prophylaxis and ART

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Abstract

Mother-to-child transmission of HIV-1 (MTCT) remains a major route of infection in South Africa, where 25% of pregnant women are HIV-infected and an estimated 70000 - 80000 HIV-infected infants are born annually. The risk of transmission is highest during labour and delivery, and studies have demonstrated that antiretroviral (ARV) treatment, initiated either antenatally or in the intrapartum period, can result in significant reductions in transmission of HIV-1 from mother to infant. Widespread introduction of these regimens to prevent MTCT in South Africa will have a major impact on controlling perinatally acquired HIV infection. The presence of ARV therapy can alter viral ecology, and if the therapy allows ongoing viral replication, drug-resistant variants may become selected as long as the drug is administered. There has been some concern that the use of ARV monotherapy for the prevention of MTCT, including zidovudine (ZDV) or nevirapine (NVP) used alone, could result in the development of drug resistance with potential implications for perinatal transmission, the choice of therapy for the HIV-infected infant and future maternal therapeutic options. In the USA and other developed countries, the detection of ZDV or other resistant variants has not been found to be associated with an increased risk of MTCT and, while perinatal transmission of a resistant variant has been reported, this occurrence appears to be infrequent and unusual. In a substudy of the Women and Infants Transmission Study Group (WITS), univariate analysis showed that ZDV resistance was not significantly associated with transmission, but when adjusted for duration of ruptured membranes and total lymphocyte count, resistance mutations conferred an increased risk of transmission. However, these women were more likely to have higher viral loads and lower CD4 counts and needed to be on ARV treatment for their own health.

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/content/m_sajhiv/3/3/EJC65717
2002-01-01
2016-12-04
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