Comparison of Nevirapine (NVP) Resistance in Ugandan Women 7 Days vs. 6–8 Weeks after Single-Dose NVP Prophylaxis: HIVNET 012

We compared nevirapine (NVP) resistance (NVPR) mutations in maternal plasma 7 days vs. 6–8 weeks after single-dose NVP prophylaxis. In the HIVNET 012 trial, Ugandan women received a single dose of NVP in labor for prevention of HIV-1 mother-to-child transmission. NVPR mutations were detected in 70 (25%) of 279 women 6–8 weeks after NVP. Samples collected 7 days after NVP were analyzed from a subset of those 279 women. Genotyping was performed with the ViroSeq HIV-1 Genotyping System. NVPR was analyzed using paired samples from 7 days and 6–8 weeks after NVP. Sixty-five women had genotyping results obtained for samples collected at both 7 days and 6–8 weeks post-NVP. Twenty-one (32%) of those women had NVPR mutations detected in one or both samples. This included three women with NVPR at 7 days only, seven with NVPR at 6–8 weeks only, and 11 with NVPR at both time points. Eight women had >1 NVPR mutation detected 7 days after NVP. Y181C was the most common NVPR mutation detected at 7 days, whereas K103N was the most common NVPR mutation detected at 6–8 weeks. We conclude that NVPR may be detected in women as early as 7 days after single-dose NVP. Complex patterns of NVPR are detected in some women. The Y181C NVPR mutation often fades from detection by 6–8 weeks. In contrast, the K103N mutation emerges more slowly, but often remains detectable 6–8 weeks after NVP.