Emergence and Persistence of Nevirapine Resistance in Breast Milk After Single-Dose Nevirapine Administration

AIDS. 2010 Feb 20;24(4):557-61. doi: 10.1097/QAD.0b013e3283346e60.


Objective: Single-dose nevirapine (NVP) (sdNVP) can reduce the risk of HIV vertical transmission. We assessed risk factors for NVP resistance in plasma and breast milk from sdNVP-exposed Ugandan women.

Methods: Samples were analyzed using the Roche AMPLICOR HIV-1 Monitor Test Kit, version 1.5, and the ViroSeq HIV-1 Genotyping System. NVP concentrations were determined by liquid chromatography with tandem mass spectroscopy.

Results: HIV genotypes (plasma and breast milk) were obtained for 30 women 4 weeks after sdNVP (HIV subtypes: 15A, 1C, 12D, two recombinant). NVP resistance was detected in 12 (40%) of 30 breast milk samples. There was a nonsignificant trend between detection of NVP resistance in breast milk and plasma (P = 0.06). There was no association of HIV resistance in breast milk with median maternal pre-NVP viral load or CD4 cell count, median breast milk viral load at 4 weeks, breast milk sodium more than 10 mmol/l, HIV subtype, or concentration of NVP in breast milk or plasma.

Conclusion: NVP resistance was frequently detected in breast milk 4 weeks after sdNVP exposure. In this study, we were unable to identify specific factors associated with breast milk NVP resistance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / analysis
  • Anti-HIV Agents / metabolism
  • Anti-HIV Agents / therapeutic use*
  • Breast Feeding
  • CD4 Lymphocyte Count
  • Chromatography, Liquid
  • Drug Resistance, Viral* / genetics
  • Female
  • Genotype
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Infections / transmission
  • HIV-1 / drug effects*
  • HIV-1 / genetics
  • HIV-1 / isolation & purification
  • Humans
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Milk, Human / chemistry
  • Milk, Human / virology*
  • Nevirapine / analysis
  • Nevirapine / metabolism
  • Nevirapine / therapeutic use*
  • Pregnancy
  • Uganda
  • Viral Load


  • Anti-HIV Agents
  • Nevirapine