Academic Journal
Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy
| Title: | Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy |
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| Authors: | Globahan Ajibola, Christopher Rowley, Dorcas Maruapula, Jean Leidner, Kara Bennett, Kathleen Powis, Roger L. Shapiro, Shahin Lockman |
| Source: | Southern African Journal of HIV Medicine, Vol 21, Iss 1, Pp e1-e4 (2020) |
| Publisher Information: | AOSIS, 2020. |
| Publication Year: | 2020 |
| Collection: | LCC:Public aspects of medicine LCC:Infectious and parasitic diseases |
| Subject Terms: | drug resistance, resistance mutations, hiv, antiretroviral treatment, botswana, Public aspects of medicine, RA1-1270, Infectious and parasitic diseases, RC109-216 |
| More Details: | Background: To reduce risk of antiretroviral resistance when stopping efavirenz (EFV)-based antiretroviral treatment (ART), staggered discontinuation of antiretrovirals (an NRTI tail) is recommended. However, no data directly support this recommendation. Objectives: We evaluated the prevalence of HIV drug resistance mutations in pregnant women living with HIV who stopped efavirenz (EFV)/emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) postpartum. Method: In accordance with the prevailing Botswana HIV guidelines at the time, women with pre-treatment CD4 350 cells/mm3, initiated EFV/FTC/TDF in pregnancy and stopped ART at 6 weeks postpartum if formula feeding, or 6 weeks after weaning. A 7-day tail of FTC/TDF was recommended per Botswana guidelines. HIV-1 RNA and genotypic resistance testing (bulk sequencing) were performed on samples obtained 4–6 weeks after stopping EFV. Stanford HIV Drug Resistance Database was used to identify major mutations. Results: From April 2014 to May 2015, 74 women who had stopped EFV/FTC/TDF enrolled, with median nadir CD4 of 571 cells/mm3. The median time from cessation of EFV to sample draw for genotyping was 5 weeks (range: 3–13 weeks). Thirty-two (43%) women received a 1-week tail of FTC/TDF after stopping EFV. HIV-1 RNA was available from delivery in 70 (95%) women, 58 (83%) of whom had undetectable delivery HIV-1 RNA ( 40 copies/mL). HIV-1 RNA was available for 71 women at the time of genotyping, 45 (63%) of whom had HIV-1 RNA 40 copies/mL. Thirty-five (47%) of 74 samples yielded a genotype result, and four (11%) had a major drug resistance mutation: two with K103N and two with V106M. All four resistance mutations occurred among women who did not receive an FTC/TDF tail (4/42, 10%), whereas no mutations occurred among 18 genotyped women who had received a 1-week FTC/TDF tail (p = 0.053). Conclusions: Viral rebound was slow following cessation of EFV/FTC/TDF in the postpartum period. Use of an FTC/TDF tail after stopping EFV was associated with the lower prevalence of subsequent NNRTI drug resistance mutation. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 1608-9693 2078-6751 |
| Relation: | https://sajhivmed.org.za/index.php/hivmed/article/view/1023; https://doaj.org/toc/1608-9693; https://doaj.org/toc/2078-6751 |
| DOI: | 10.4102/sajhivmed.v21i1.1023 |
| Access URL: | https://doaj.org/article/85c46b34ad0740a6b31cd46f6c981811 |
| Accession Number: | edsdoj.85c46b34ad0740a6b31cd46f6c981811 |
| Database: | Directory of Open Access Journals |
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| ISSN: | 16089693 20786751 |
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| DOI: | 10.4102/sajhivmed.v21i1.1023 |
| Published in: | Southern African Journal of HIV Medicine |
| Language: | English |