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Prophylactic regimens to prevent mother-to-child transmission of HIV and their effect on future therapy

James McIntyre and Neil Martinson

The use of combination antiretroviral treatment for the prevention of mother-to-child transmission (PMTCT) of HIV has been extremely successful in reducing pediatric HIV infection and is the standard of care in well-resourced settings. In most high-prevalence, less-resourced settings, short-course, single or combination antiretroviral regimens have been the only available PMTCT interventions. Concerns have emerged around the potential impact of viral resistance selected following the use of nevirapine as single-dose or in short-course combination regimens, and the use of lamivudine in short-course dual therapy regimens. Early data have suggested a reduced response to non-nucleoside reverse transcriptase inhibitor-containing treatment regimens where these are started less than 6 months after pregnancy exposure to nevirapine, but no difference in clinical or virologic outcome if initiated more than 6 months after this PMTCT exposure. Treatment response to lamivudine-containing regimens may be diminished following nonsuppressive zidovudine and lamivudine combination PMTCT regimens.