The Role of Antiretrovirals and Drug Resistance in Vertical Transmission of HIV‐1 Infection
- 1 November 2000
- journal article
- review article
- Published by Wiley in Annals of the New York Academy of Sciences
- Vol. 918 (1), 9-15
- https://doi.org/10.1111/j.1749-6632.2000.tb05467.x
Abstract
Large‐cohort studies in North America, Europe, and Thailand have shown that zidovudine/azidothymidine (AZT) monotherapy, given at the late stages of pregnancy, is of proven benefit in reducing mother‐to‐infant HIV transmission by 51% to 68%. AZT monotherapy will not be of long‐term benefit for mothers because no single drug can counteract viral infection; benefits to babies will be short‐lived if HIV‐1 is acquired through breastfeeding after birth. Unfortunately, ongoing mutation of HIV under conditions of drug pressure allows for the evolution and selection of AZT‐resistant viruses. Emergence of AZT‐resistant variants in pregnant mothers (7‐29%) and their infected offspring (5‐21%) has been described in several studies. Drug resistance arises more frequently in those mothers who received AZT therapy before pregnancy. Recent advances in combination chemotherapy may provide alternative strategies in prevention of vertical transmission and drug resistance. Genotypic screening of the HIV‐1 isolated from pregnant mothers may provide rational modifications in antiretroviral (ARV) strategies to circumvent vertical HIV transmission. This may be of advantage for resource‐rich nations but not for underdeveloped nations with limited access to ARVs. Public health programs are vital to have an impact on the tragic pandemic of pediatric AIDS.Keywords
This publication has 21 references indexed in Scilit:
- Prevalence of HIV-1 resistant to antiretroviral drugs in 81 individuals newly infected by sexual contact or injecting drug useAIDS, 2000
- Mother-to-Infant Transmission of the Human Immunodeficiency Virus during Primary InfectionNew England Journal of Medicine, 1999
- Trends in Human Immunodeficiency Virus (HIV) Counseling, Testing, and Antiretroviral Treatment of HIV‐Infected Women and Perinatal Transmission in North CarolinaThe Journal of Infectious Diseases, 1999
- Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire: a randomised trialThe Lancet, 1999
- Development of zidovudine-resistant HIV genotypes following postnatal prophylaxis in a perinatally infected infantAIDS, 1996
- Effects of Zidovudine Use During Pregnancy on Resistance and Vertical Transmission of Human Immunodeficiency Virus Type 1Clinical Infectious Diseases, 1995
- A Risk-Benefit Assessment of Zidovudine in the Prevention of Perinatal HIV TransmissionDrug Safety, 1995
- Mother to child transmission of zidovudine-resistant HIV-1The Lancet, 1994
- Risk factors for vertical transmission of HIV-1 and early markers of HIV-1 infection in childrenAIDS, 1993
- HIV with Reduced Sensitivity to Zidovudine (AZT) Isolated During Prolonged TherapyScience, 1989