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Detection of the onset of drug resistant mutations in pregnant women receiving single dose nevirapine in Namakkal, Tamilnadu, using oligonucleotide ligation assay
Presented by Saramma Mini Jacob, India.
Jacob S.M.1, Durairaj A.1, Vijayakumari J.J.1, Srijayanth P.1, Melvin A.J.2, Frenkel L.M.3, Samuel N.M.1
1Tamilnadu Dr MGR Medical University, Department of Experimental Medicine, Chennai, India, 2Children's Hospital and Regional Medical Center, Division of Infectious Diseases, Seattle, United States, 3University of Washington and Children's Hospital, Pediatrics and Laboratory Medicine, Seattle, United States
Objectives: To detect the onset and persistence of drug-resistant virus after single dose of Nevirapine (sdNVP) provided to delivering seropositive women and to evaluate the time taken for its decay.
Methods: 36 consenting HIV seropositive pregnant women who received sdNVP at the time of delivery and who delivered at Namakkal District Headquarter Hospital from January to December 2005 were enrolled into the study. Complete blood counts (Cell counter), CD4/CD8 Counts (flow cytometry), HIV1 Viral load (Roche HIV1 Monitor test Version 1.5) and resistance testing using OLA (Oligonucleotide Ligase Assay) were performed at delivery. OLA was performed for sequential whole blood samples collected at delivery, 7-10 days after delivery, 6 weeks, 4th, 6th months and one year postpartum. OLA estimated the K103N and Y181C mutations and the wild type virus.
Results: In the cohort of 36 women, mean age was 25 years with a range 19-36 years. The mean hemoglobin for these women was 10.4gm and the mean Total Lymphocyte counts was 1783 cells. Median CD4 counts estimated for 64% of women (n=23) was 338 cells/cmm (range 94-1038) and mean viral load for 15/36 women was 11,609 copies/ml of plasma. Nevirapine resistance mutations were detected in 28% (10/36) of women - 22% K103N, 5.5% Y181C. 70% (7/10) of the mutations were detected at 6 weeks after delivery. In two women K103N mutation was detected at 6 months postpartum. Wild type virus had replaced the mutants by one year postpartum in all women except one.
Conclusions: Nevirapine resistant mutations were detected in 28% of women who received sdNVP at the time of delivery. 70% of the mutations appear at 6 weeks after delivery. These mutations were not observed by one year postpartum except in one woman. These observations are relevant for future treatment (non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens) of these women for their HIV disease.
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