Journal article
Addition of 7 Days of Zidovudine Plus Lamivudine to Peripartum Single-Dose Nevirapine Effectively Reduces Nevirapine Resistance Postpartum in HIV-Infected Mothers in Malawi
Journal of acquired immune deficiency syndromes (1999), Vol.54(5), pp.515-523
08/15/2010
DOI: 10.1097/QAI.0b013e3181e3a70e
PMCID: PMC2913302
PMID: 20672451
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.
Details
- Title: Subtitle
- Addition of 7 Days of Zidovudine Plus Lamivudine to Peripartum Single-Dose Nevirapine Effectively Reduces Nevirapine Resistance Postpartum in HIV-Infected Mothers in Malawi
- Creators
- Sherry L. Farr - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA 30345 USAJulie A. E. Nelson - Univ N Carolina, UNC Ctr AIDS Res, Chapel Hill, NC USAThokozani J. Ng'ombe - UNC Project, Lilongwe, MalawiAthena P. Kourtis - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA 30345 USACharles Chasela - UNC Project, Lilongwe, MalawiJeffrey A. Johnson - Ctr Dis Control & Prevent, Div HIV AIDS Lab, Atlanta, GA 30345 USAAngela D. M. Kashuba - Univ N Carolina, UNC Ctr AIDS Res, Chapel Hill, NC USAGerald L. Tegha - UNC Project, Lilongwe, MalawiJeffrey Wiener - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA 30345 USAJoseph J. Eron - University of North Carolina at Chapel HillHarriet N. Banda - University of North Carolina at Chapel HillMwanangwa Mpaso - UNC Project, Lilongwe, MalawiJonathan Lipscomb - Ctr Dis Control & Prevent, Div HIV AIDS Lab, Atlanta, GA 30345 USAChrissie Matiki - UNC Project, Lilongwe, MalawiSusan A. Fiscus - Univ N Carolina, UNC Ctr AIDS Res, Chapel Hill, NC USADenise J. Jamieson - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA 30345 USACharles van der Horst - University of North Carolina at Chapel HillBreastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
- Resource Type
- Journal article
- Publication Details
- Journal of acquired immune deficiency syndromes (1999), Vol.54(5), pp.515-523
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/QAI.0b013e3181e3a70e
- PMID
- 20672451
- PMCID
- PMC2913302
- ISSN
- 1525-4135
- eISSN
- 1944-7884
- Number of pages
- 9
- Grant note
- Centers for Disease Control and Prevention; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA Bristol-Myers Squibb USAID; United States Agency for International Development (USAID) Elizabeth Glaser Pediatric AIDS Foundation UNICEF D43TW001039 / FOGARTY INTERNATIONAL CENTER; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) P30-AI50410 / NIAID University of North Carolina Center for AIDS Research Johnson and Johnson; Johnson & Johnson; Johnson & Johnson USA P30AI050410 / NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Boehringer-Ingelheim; Boehringer Ingelheim GlaxoSmithKline Abbott Laboratories Roche Pharmaceuticals; Roche Holding Malawi Ministry of Health and Population DHHS/NIH/FIC 2-D43 / AIDS International Training and Research Program
- Language
- English
- Date published
- 08/15/2010
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446280102771
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