Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy

Southern African Journal of HIV Medicine

Field Value
Title Drug resistance after cessation of efavirenz-based antiretroviral treatment started in pregnancy
Creator Ajibola, Globahan Rowley, Christopher Maruapula, Dorcas Leidner, Jean Bennett, Kara Powis, Kathleen Shapiro, Roger L. Lockman, Shahin
Subject HIV Medicine drug resistance; resistance mutations; HIV; antiretroviral treatment; Botswana
Description 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.
Publisher AOSIS
Contributor The National Institute of Child Health and Human Development and The National Institute of Allergy and Infectious Diseases, NIH
Date 2020-01-27
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v21i1.1023
Source Southern African Journal of HIV Medicine; Vol 21, No 1 (2020); 4 pages 2078-6751 1608-9693
Language eng
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https://sajhivmed.org.za/index.php/hivmed/article/view/1023/1761 https://sajhivmed.org.za/index.php/hivmed/article/view/1023/1762 https://sajhivmed.org.za/index.php/hivmed/article/view/1023/1763 https://sajhivmed.org.za/index.php/hivmed/article/view/1023/1760
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Rights Copyright (c) 2020 Globahan Ajibola, Christopher Rowley, Dorcas Maruapula, Jean Leidner, Kara Bennett, Kathleen Powis, Roger L. Shapiro, Shahin Lockman https://creativecommons.org/licenses/by/4.0