Antiretroviral Resistance Mutations among Pregnant Human Immunodeficiency Virus Type 1–Infected Women and Their Newborns in the United States: Vertical Transmission and Clades

To assess the impact of antiretroviral resistance on perinatal transmission prevention efforts, human immunodeficiency virus type 1 (HIV-1) genotypic resistance testing was done for 220 HIV-1–infected, zidovudine (AZT)–exposed pregnant women and 24 of their infected infants. The women were prospectively enrolled in 4 US cities in 1991–1997. Phylogenetic and sequencing analyses revealed 5 women with non–clade B infections traced to western African origins. AZT-associated mutations were detected in 17.3% of pregnant women, whereas genotypic resistance to nonnucleoside reverse-transcriptase inhibitors and protease inhibitors was infrequent. No significant association was detected between perinatal transmission and the presence of either AZT or nucleoside reverse-transcriptase inhibitor resistance–associated mutations. AZT resistance mutations were detected in 2 (8.3%) neonatal samples, but the mutation pattern was not identical to the mother’s. Although no effect of viral resistance on mother-infant transmission was demonstrated, the advent of more-potent drug classes and the potential for the rapid emergence of resistance warrant prospective surveillance