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Minority M184V variants in women exposed to 3TC/FTC-containing lopinavir-ritonavir (LPVr) regimens in pregnancy
© Surah et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Purpose of the study
Short-term antiretroviral therapy (START) consisting of 2 NRTIs and a ritonavir boosted PI is widely used in pregnancy. Resistance is rarely detected using population based sequencing. The aim of this study was to determine whether minority M184V variants emerge with 3TC/FTC containing START regimens in pregnancy and if so whether this impacted upon future treatment outcomes.
Multi-centre study. An allele-specific real time PCR (ASPCR), optimized for subtypes B, C and AG, was used to detect minority M184V variants. Participants took START for the prevention of HIV mother-to-child transmission (PMTCT). All received standard dose LPVr. Plasma samples were tested pre and post treatment. Routine population based sequencing was also performed.
Summary of results
M184V mutants N=7
Median Age, yrs (range)
South American origin
Median gestation at START initiation, completed weeks (range)
Median duration START, days (range)
Virological suppression at delivery
6 (86%) (other VL 57c/ml)
Previous ART regimens
ZDVm, CBV/nelfinavir, CBV/nelfinavir
Population based sequencing performed
10/11 (91%) (1 failed)
WT on population based sequencing
Number of Lopinavir TDM performed
Median Lopinavir concentration (µg/L) (range)
Virological suppression with subsequent ART
2/3 (67%) (1 stopped after a few weeks)
M184V mutants were detected after LPVr based START for PMTCT in 22.5% women. No difference in prior ART, START duration, drug concentration or virological suppression was observed. The presence of minority M184V variants post-partum did not affect future treatment success. The possible association with HIV-1 subtype C requires further evaluation but clade effect on the development of resistance has been reported following intra-partum nevirapine.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.