Addition of 7 days of zidovudine plus lamivudine to peripartum single-dose nevirapine effectively reduces nevirapine resistance postpartum in HIV-infected mothers in Malawi.
Farr SL,
Nelson JA,
Ng'ombe TJ,
Kourtis AP,
Chasela C,
Johnson JA,
Kashuba AD,
Tegha GL,
Wiener J,
Eron JJ,
Banda HN,
Mpaso M,
Lipscomb J,
Matiki C,
Fiscus SA,
Jamieson DJ,
van der Horst C;
BAN Study Team.
Adair L, Ahmed Y, Ait-Khaled M, Albrecht S, Bangdiwala S, Bayer R, Bentley M, Bramson B, Bobrow E, Boyle N, Butera S, Chasela C, Chavula C, Chimerang'ambe J, Chigwenembe M, Chikasema M, Chikhungu N, Chilongozi D, Chiudzu G, Chome L, Cole A, Corbett A, Corneli A, Duerr A, Eliya H, Ellington S, Eron J, Farr S, Ferguson YO, Fiscus S, Galvin S, Guay L, Heilig C, Hoffman I, Hooten E, Hosseinipour M, Hudgens M, Hurst S, Hyde L, Jamieson D, Joaki G, Jones D, Kacheche Z, Kamanga E, Kamanga G, Kampani C, Kamthunzi P, Kamwendo D, Kanyama C, Kashuba A, Kathyola D, Kayira D, Kazembe P, King C, Knight R, Kourtis AP, Krysiak R, Kumwenda J, Loeliger E, Luhanga M, Madhlopa V, Majawa M, Maida A, Marcus C, Martinson F, Thoofer N, Matiki C, Mayers D, Mayuni I, McDonough M, Meme J, Merry C, Mita K, Mkomawanthu C, Mndala G, Mndala I, Moses A, Msika A, Msungama W, Mtimuni B, Muita J, Mumba N, Musis B, Mwansambo C, Mwapasa G, Nkhoma J, Pendame R, Piwoz E, Raines B, Ramdas Z, Rublein J, Ryan M, Sanne I, Sellers C, Shugars D, Sichali D, Snowden W, Soko A, Spensley A, Steens JM, Tegha G, Tembo M, Thomas R, Tien HC, Tohill B, van der Horst C, Waalberg E, Wiener J, Wilfert C, Wiyo P, Zgambo I, Zimba C.
Source
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30345, USA. sfarr@cdc.gov
Erratum in
- J Acquir Immune Defic Syndr. 2011 Oct 1;58(2):e53.
Abstract
BACKGROUND:
We assessed whether 7 days of zidovudine + lamivudine postpartum with single-dose nevirapine at labor decreases nevirapine resistance in HIV-infected women in Malawi.
METHODS:
HIV-infected pregnant women receiving intrapartum single-dose nevirapine and 7 days of zidovudine + lamivudine (n = 132) and women receiving intrapartum single-dose nevirapine alone (n = 66) were followed from an antenatal visit through 6 weeks postpartum. Plasma specimens at 2 and 6 weeks postpartum were tested for genotypic resistance to nevirapine by population sequencing and sensitive real-time polymerase chain reaction. Poisson regression was used to determine predictors of postpartum nevirapine resistance.
RESULTS:
Median HIV RNA was similar at entry (4.27 log vs. 4.35 log, P = 0.87), differed at 2 weeks postpartum (2.67 log vs. 3.58 log, P < 0.0001) but not at 6 weeks postpartum (4.49 log vs. 4.40 log, P = 0.79), between single-dose nevirapine/zidovudine + lamivudine and single-dose nevirapine groups, respectively. Nevirapine resistance, measured by population sequencing and sensitive real-time polymerase chain reaction, was significantly less common in those receiving single-dose nevirapine/zidovudine + lamivudine compared with single-dose nevirapine, respectively, at 2 weeks [10% (4 of 40) vs. 74% (31 of 42), P < 0.0001] and 6 weeks postpartum [10% (11 of 115) vs. 64% (41 of 64), P < 0.0001; adjusted relative risk = 0.18, 95% confidence interval (0.10 to 0.34)].
CONCLUSIONS:
The significant decrease in nevirapine resistance conferred by 1 week of zidovudine + lamivudine should help policymakers optimize peripartum HIV prophylaxis recommendations.
- PMID:
- 20672451
- [PubMed - indexed for MEDLINE]
- PMCID: PMC2913302
Free PMC ArticleFigure 2Prevalence of NVP resistance mutations by drug regimen among HIV-infected mothers*, Lilongwe, Malawi
*Among women with testable plasma specimens at 2 weeks (sdNVP: n=45; sdNVP/ZDV+3TC: n=53) and 6 weeks postpartum (sdNVP: n=65; sdNVP/ZDV+3TC: n=120) and no NVP resistance at an antenatal visit
J Acquir Immune Defic Syndr. J Acquir Immune Defic Syndr;54(5):515-523.
Figure 1Median viral load† and percent of women with detectable nevirapine‡ (NVP) by drug regimen among HIV-infected mothers*, Lilongwe, Malawi
*Among women with testable plasma specimens at 2 weeks (sdNVP: n=45; sdNVP/ZDV+3TC: n=53) and 6 weeks postpartum (sdNVP: n=65; sdNVP/ZDV+3TC: n=120);
†Chi square p-value for viral load: antenatal: p=0.87; 2 weeks postpartum: p<0.0001, 6 weeks postpartum: p=0.79
‡Chi square p-value for NVP concentration: delivery: p=0.47; 2 weeks postpartum: p<0.0001; 6 weeks postpartum: p=0.79
J Acquir Immune Defic Syndr. J Acquir Immune Defic Syndr;54(5):515-523.
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