Publication:
Effectiveness of non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in women previously exposed to a single intrapartum dose of nevirapine: A multi-country, prospective cohort study

Issued Date

2010-02-01

Resource Type

Article

ISSN

15491676
15491277

DOI

10.1371/journal.pmed.1000233

Other identifier(s)

2-s2.0-77649083137

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

PLoS Medicine. Vol.7, No.2 (2010)

Suggested Citation

Jeffrey S A Stringer, Michelle S. McConnell, James Kiarie, Omotayo Bolu, Thanomsak Anekthananon, Tavatchai Jariyasethpong, Dara Potter, Winnie Mutsotso, Craig B. Borkowf, Dorothy Mbori-Ngacha, Peter Muiruri, John Odero Ong'ech, Isaac Zulu, Lungowe Njobvu, Bongkoch Jetsawang, Sonal Pathak, Marc Bulterys, Nathan Shaffer, Paul J. Weidle Effectiveness of non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in women previously exposed to a single intrapartum dose of nevirapine: A multi-country, prospective cohort study. PLoS Medicine. Vol.7, No.2 (2010). doi:10.1371/journal.pmed.1000233 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/29790

Research Projects

Organizational Units

Authors

Journal Issue

Thesis

Title

Effectiveness of non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in women previously exposed to a single intrapartum dose of nevirapine: A multi-country, prospective cohort study

Author(s)

Jeffrey S A Stringer
 Michelle S. McConnell
 James Kiarie
 Omotayo Bolu
 Thanomsak Anekthananon
 Tavatchai Jariyasethpong
 Dara Potter
 Winnie Mutsotso
 Craig B. Borkowf
 Dorothy Mbori-Ngacha
 Peter Muiruri
 John Odero Ong'ech
 Isaac Zulu
 Lungowe Njobvu
 Bongkoch Jetsawang
 Sonal Pathak
 Marc Bulterys
 Nathan Shaffer
 Paul J. Weidle

Other Contributor(s)

Centre for Infectious Disease Research in Zambia
 Thailand Ministry of Public Health
 Centers for Disease Control and Prevention
 Kenyatta National Hospital
 University of Nairobi
 Mahidol University
 Rajavithi Hospital
 CDC Global AIDS Program
 Global AIDS Program
 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
 University Teaching Hospital Lusaka
 Northrop Grumman corporation

Abstract

Background: Intrapartum and neonatal single-dose nevirapine (NVP) reduces the risk of mother-to-child HIV transmission but also induces viral resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. This drug resistance largely fades over time. We hypothesized that women with a prior single-dose NVP exposure would have no more than a 10% higher cumulative prevalence of failure of their NNRTI-containing antiretroviral therapy (ART) over the first 48 wk of therapy than would women without a prior exposure. Methods and Findings: We enrolled 355 NVP-exposed and 523 NVP-unexposed women at two sites in Zambia, one site in Kenya, and two sites in Thailand into a prospective, non-inferiority cohort study and followed them for 48 wk on ART. Those who died, discontinued NNRTI-containing ART, or had a plasma viral load ≥400 copies/ml at either the 24 wk or 48 wk study visits and confirmed on repeat testing were characterized as having failed therapy. Overall, 114 of 355 NVP-exposed women (32.1%) and 132 of 523 NVP-unexposed women (25.2%) met criteria for treatment failure. The difference in failure rates between the exposure groups was 6.9% (95% confidence interval [CI] 0.8%-13.0%). The failure rates of women stratified by our predefined exposure interval categories were as follows: 47 of 116 women in whom less than 6 mo elapsed between exposure and starting ART failed therapy (40%; p<0.001 compared to unexposed women); 25 of 67 women in whom 7-12 mo elapsed between exposure and starting ART failed therapy (37%; p = 0.04 compared to unexposed women); and 42 of 172 women in whom more than 12 mo elapsed between exposure and starting ART failed therapy (24%; p = 0.82 compared to unexposed women). Locally weighted regression analysis also indicated a clear inverse relationship between virologic failure and the exposure interval. Conclusions: Prior exposure to single-dose NVP was associated with an increased risk of treatment failure; however, this risk seems largely confined to women with a more recent exposure. Women requiring ART within 12 mo of NVP exposure should not be prescribed an NNRTI-containing regimen as first-line therapy.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/29790

Collections

Scopus 2006-2010