Prophylaxis for the Prevention of Mother-to-Child Transmission of HIV-l

We analyzed the development of nevirapine (NVP) resistance in human immunodeficiency virus type 1 (HIV-l)-infected Malawian infants who received regimens containing single-dose NVP (SD-NVP) for the prevention of mother-to-child transmission (MTCT) of HIV-l. All infants received SD-NVP, and some randomly received zidovudine (ZDV) as well. Mothers did or did not receive SD-NVP on the basis ofwhen they arrived at the hospital for delivery. In infants 6-8 weeks of age, NVP resistance was less frequent when infants had received SD-NVP plus ZDV and mothers had not received SD-NVP than when infants had received SD-NVP alone and mothers had received SD-NVP (4/15 [27%] vs. 20123 [87%]; P<.001). The risk of MTCT of HIV-l was comparable with these regimens. Infant-only prophylaxis also eliminates the development of NVP resistance in mothers. Regimens containing single-dose nevirapine (SD-NVP) that are provided to pregnant women and/or their infants can prevent mother-to-child transmission (MTCT) of HIV-l [1-4]. How-ever, these regimens are associated with the development of NVP resistance in some women and infants who become in-fected with HIV-l despite the receipt of antiretroviral prophy