Preventing Mother-to-Child Transmission of Human Immunodeficiency Virus-1 (HIV-1): Effects of Intrapartum and Neonatal Single-Dose Nevirapine Prophylaxis and Subsequent HIV-1 Drug Resistance at Antiretroviral Treatment Initiation
Open Access Senior Thesis
Bachelor of Arts
W.M. Keck Science Department
James C. Higdon
Karl A. Haushalter
© 2011 Amanda L. Harmon
The prevention of mother-to-child transmission is one of the most powerful tools in human immunodeficiency virus type 1 (HIV-1) prevention and has huge potential to improve both maternal and child health. In the absence of any preventative measures, infants born to and breastfed by their HIV-positive mothers have roughly a one-in-three chance of acquiring the infection themselves. HIV can be passed on from mother-to-child during pregnancy, during labor and delivery, and even after during breastfeeding.
Intrapartum and neonatal single-dose nevirapine (sd-NVP) is the foundation of preventing mother-to-child transmission in lower resource settings where it has been used alone or as part of combination regimens. Both its simplicity and its long plasma half-life contribute to the success of sd-NVP based therapy. However, sd-NVP frequently results in HIV-1 viral resistance in mothers and children who become HIV infected despite prophylaxis. Sd-NVP leads to the development of non-nucleoside reverse transcriptase inhibitors (NNRTI) drug resistance, compromising the success of treatment of mother and child with subsequent antiretroviral combinations. Resistance to NNRTIs is particularly worrisome in lower resource settings since many subsequent regimens for maternal and infant antiretroviral therapy include a NNRTI drug.
Harmon, Amanda L., "Preventing Mother-to-Child Transmission of Human Immunodeficiency Virus-1 (HIV-1): Effects of Intrapartum and Neonatal Single-Dose Nevirapine Prophylaxis and Subsequent HIV-1 Drug Resistance at Antiretroviral Treatment Initiation" (2011). CMC Senior Theses. Paper 305.