@article{fdi:010048569,
  title = {{E}fficacy and safety of 1-month postpartum {Z}idovudine-{D}idanosine to prevent {HIV}-resistance mutations after intrapartum single-dose {N}evirapine},
  author = {{L}allemant, {M}arc and {N}go-{G}iang-{H}uong, {N}icole and {J}ourdain, {G}onzague and {T}raisaithit, {P}. and {C}ressey, {T}im and {C}ollins, {I}. {J}. and {J}arupanich, {T}. and {S}ukhumanant, {T}. and {A}chalapong, {J}. and {S}absanong, {P}. and {C}hotivanich, {N}. and {W}iniyakul, {N}. and {A}riyadej, {S}. and {K}anjanasing, {A}. and {R}atanakosol, {J}. and {H}emvuttiphan, {J}. and {K}engsakul, {K}. and {W}annapira, {W}. and {S}ittipiyasakul, {V}. and {P}ornkitprasarn, {W}. and {L}iampongsabuddhi, {P}. and {M}c{I}ntosh, {K}. and {V}an {D}yke, {R}. {B}. and {F}renkel, {L}. {M}. and {K}oetsawang, {S}. and {L}e {C}oeur, {S}ophie and {K}anchana, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground. {I}ntrapartum single-dose nevirapine plus third trimester maternal and infant zidovudine are essential components of programs to prevent mother-to-child transmission of human immunodeficiency virus ({HIV}) in resource-limited settings. {T}he persistence of nevirapine in the plasma for 3 weeks postpartum risks selection of resistance mutations to nonnucleoside reverse-transcriptase inhibitors ({NNRTI}s). {W}e hypothesized that a 1-month zidovudine-didanosine course initiated at the same time as single-dose nevirapine (sd{NVP}) would prevent the selection of nevirapine-resistance mutations. {M}ethods. {HIV}-infected pregnant women in the {PHPT}-4 cohort with {CD}4 cell counts >250 cells/mm(3) received antepartum zidovudine from the third trimester until delivery, sd{NVP} during labor, and a 1-month zidovudine-didanosine course after delivery. {T}hese women were matched on the basis of baseline {HIV} load, {CD}4 cell count, and duration of antepartum zidovudine to women who received sd{NVP} in the {PHPT}-2 trial (control subjects). {C}onsensus sequencing and the more sensitive oligonucleotide ligation assay were performed on samples obtained on postpartum days 7-10, 37-45, and 120 (if the {HIV} load was >500 copies/m{L}) to detect {K}103{N}/{Y}181{C}/{G}190{A} mutations. {R}esults. {T}he 222 {PHPT}-4 subjects did not differ from matched control subjects in baseline characteristics except for age. {T}he combined group median {CD}4 cell count was 421 cells/mm(3) (interquartile range [{IQR}], 322-549 cells/mm3), the median {HIV} load was 3.45 log(10) copies/m{L} ({IQR}, 2.79-4.00 log(10) copies/m{L}), and the median duration of zidovudine prophylaxis was 10.4 weeks ({IQR}, 9.1-11.4 weeks). {U}sing consensus sequencing, major {NNRTI} resistance mutations were detected after delivery in 0% of {PHPT}-4 subjects and 10.4% of {PHPT}-2 controls. {T}he oligonucleotide ligation assay detected resistance in 1.8% of {PHPT}-4 subjects and 18.9% of controls. {M}ajor {NNRTI} resistance mutations were detected by either method in 1.8% of {PHPT}-4 subjects and 20.7% of controls ({P}<.001). {C}onclusions. {A} 1-month postpartum course of zidovudine plus didanosine prevented the selection of the vast majority of {NNRTI} resistance mutations.},
  keywords = {},
  booktitle = {},
  journal = {{C}linical {I}nfectious {D}iseases},
  volume = {50},
  numero = {6},
  pages = {898--908},
  ISSN = {1058-4838},
  year = {2010},
  DOI = {10.1086/650745},
  URL = {https://www.documentation.ird.fr/hor/fdi:010048569},
}