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15th Conference on Retroviruses and Opportunistic InfectionsBoston, Massachusetts - February 3-6, 2008 |
Conf Retrovir Opportunistic Infect 2008 Feb 3-6;15: (abstract no. 48)
Paul Weidle
1, J Stringer2, M
McConnell1,3, J Kiarie4, T Anekthananon5, T Jariyasethpong6, D Potter2, W Mutsotso7, C Borkowf1, O Bolu1, and The NNRTI Response Study Team
1CDC, Atlanta, GA, US; 2Univ of Alabama at Birmingham, Ctr for Infectious Disease Res in Zambia, Lusaka; 3Thailand Ministry of Publ Hlth-US CDC Collaboration, Nonthaburi; 4Kenyatta Natl Hosp, Univ of Nairobi, Kenya;
5Siriraj Hosp., Mahidol Univ., Bangkok, Thailand; 6Rajavithi Hosp, Bangkok, Thailand; and 7CDC Kenya, Nairobi
BACKGROUND: Maternal-infant single-dose nevirapine (NVP) reduces perinatal HIV transmission, but induces viral resistance to NNRTI drugs in some women. Prior single-dose NVP exposure may compromise future maternal treatment with NNRTI-based ART.
METHODS: Between May 2005 and January 2007, we enrolled single-dose NVP-exposed and unexposed women starting NNRTI-based ART in a prospective cohort study in Zambia, Thailand, and Kenya. Women were frequency matched at entry by World Health Organization (WHO) stage and CD4 cell count. We compared treatment failure (viral load ≥400 copies/mL, not on NNRTI, died) between exposure groups at 6 months after ART initiation.
RESULTS: We studied 878 women (355 single-dose NVP-exposed, 523 unexposed). Single-dose NVP-exposed women were younger (29 vs 33 years, p<0.001), had a higher median CD4 (160 vs 139 cells/mm3 p=0.007), and lower median viral load (97,300 vs 142,000 copies/mL, p=0.02), but were of similar weight (51 vs 52 kg, p=0.4). At 6 months after ART initiation, 186 (21%) women had failed (76 had viral load ≥400 copies/mL, 51 discontinued the study, 48 died, and 11 had been changed to a protease inhibitor). Women with exposure to single-dose NVP ≤6 months before NNRTI-based ART initiation, with baseline CD4 0 to 49 cells/mm3, or viral load >100,000 copies/mL had poorer treatment responses (see the table). Women exposed to single-dose NVP >12 months before NNRTI-based ART did as well as unexposed women. In a secondary analysis including only those still on NNRTI-based ART at 6 months, we found similar results.
| Baseline co-variates | n | Multivariate odds ratio for treatment failure at 6 months adjusted for age | CI95 | |
| Time since single-dose NVP exposure (months) | Unexposed ≤6 7 to 12 >12 |
523 115 67 173 |
1.0 1.86 1.61 0.90 |
1.12 to 3.09 0.87 to 2.98 0.56 to 1.45 |
| Country | Thailand Zambia Kenya |
217 509 152 |
1.0 2.00 1.47 |
1.23 to 3.23 0.81 to 2.65 |
| CD4 (cells/mm3) | ≥200 50 to 199 0 to 49 |
255 479 144 |
1.0 1.42 3.21 |
0.91 to 2.21 1.88 to 5.49 |
| Viral load (copies/mL) | <10,000 10,000 to 99,999 ≥100,000 Missing |
114 296 462 6 |
1.0 1.86 2.25 . |
0.95 to 3.62 1.17 to 4.29 |
| WHO Stage | I/II III IV |
416 358 104 |
1.0 1.42 1.65 |
0.95 to 2.10 0.96 to 2.84 |
CONCLUSIONS: A high proportion (79%) of women in this cohort responded to 6 months of NNRTI-based ART, whether previously exposed to single-dose NVP or not. These data do suggest an increased risk of treatment failure among women with recent single-dose NVP exposure, but not with single-dose NVP exposure >12 months before initiation of NNRTI-based ART. Treatment with ART or perinatal HIV prevention strategies other than single-dose NVP should be considered for pregnant women who are likely to initiate ART within 1 year after delivery.
2008-02-03
48
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