@article{fdi:010054298,
  title = {{A} comparison of 3 regimens to prevent nevirapine resistance mutations in hiv-infected pregnant women receiving a single intrapartum dose of nevirapine},
  author = {{V}an {D}yke, {R}.{B}. and {N}go-{G}iang-{H}uong, {N}icole and {S}hapiro, {D}.{E}. and {F}renkel, {L}. and {B}ritto, {P}. and {R}oongpisuthipong, {A}. and {B}eck, {I}.{A}. and {Y}uthavisuthi, {P}. and {P}rommas, {S}. and {P}uthanakit, {T}. and {A}chalapong, {J}. and {C}hotivanich, {N}. and {R}asri, {W}. and {C}ressey, {T}. and {M}aupin, {R}. and {M}irochnick, {M}. and {J}ourdain, {G}onzague},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground. {I}ntrapartum single-dose ({SD}) nevirapine ({NVP}) reduces perinatal transmission of human immunodeficiency virus ({HIV}) infection but selects for {NVP}-resistant virus, which compromises subsequent {NVP}-based therapy. {A} 1-week "tail" of lamivudine and zidovudine after {SD}-{NVP} decreases the risk of resistance. {W}e hypothesized that increasing the duration or potency of the tail would further reduce this risk to < 10%, using a sensitive assay to measure resistance. {M}ethods. {HIV}-infected pregnant {T}hai women with a {CD}4 cell count > 250 cells/mu {L}, most receiving zidovudine, were randomized at 28-38 weeks gestation to receive 1 of 3 intrapartum and postpartum regimens: ({A}) zidovudine plus enteric-coated didanosine plus lopinavir and ritonavir for 7 days, ({B}) zidovudine plus enteric-coated didanosine for 30 days, or ({C}) regimen 1 for 30 days. {T}he incidence of {NVP} resistance mutations at day 10 or week 6 post partum in each arm was compared with that of a historical comparison group who received prenatal zidovudine and {SD}-{NVP}. {NVP} resistance was identified by consensus sequencing and a sensitive oligonucleotide ligation assay ({OLA}). {R}esults. {A}t entry, the 169 participants had a median {CD}4 cell count of 456 cells/mu {L} and an {HIV} load of 3.49 log(10) copies/m{L}. {T}he incidence of mutations in each of the 3 {P}1032 arms was 0% by sequencing and 1.8%, 7.1%, and 5.3% by {OLA} in arms {A}, {B}, and {C}, respectively, compared with 13.4% by sequencing and 29.4% by {OLA} in the comparison group ({P} < .001 for each study arm vs comparison group). {G}rade 4 anemia developed in 1 woman. {C}onclusions. {A} 7-day tail of highly active combination therapy or 1 month of dual therapy after {SD}-{NVP} prevents most {NVP} resistance to minimal toxicity. {C}linical {T}rials {R}egistration. {T}he {IMPAACT} {P}1032 {C}linical {T}rial is {NCT}00109590, and the {PHPT}-2 {C}linical {T}rial is {NCT}00398684.},
  keywords = {{THAILANDE}},
  booktitle = {},
  journal = {{C}linical {I}nfectious {D}iseases},
  volume = {54},
  numero = {2},
  pages = {285--293},
  ISSN = {1058-4838},
  year = {2012},
  DOI = {10.1093/cid/cir798},
  URL = {https://www.documentation.ird.fr/hor/fdi:010054298},
}