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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antiretroviral therapies in women after single-dose nevirapine exposure
New England Journal of Medicine, Volume 363, No. 16, Year 2010
Notification
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Description
Background: Peripartum administration of single-dose nevirapine reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) but selects for nevirapineresistant virus. Methods: In seven African countries, women infected with HIV-1 whose CD4+ T-cell counts were below 200 per cubic millimeter and who either had or had not taken singledose nevirapine at least 6 months before enrollment were randomly assigned to receive antiretroviral therapy with tenofovir - emtricitabine plus nevirapine or tenofovir- emtricitabine plus lopinavir boosted by a low dose of ritonavir. The primary end point was the time to confirmed virologic failure or death. Results: A total of 241 women who had been exposed to single-dose nevirapine began the study treatments (121 received nevirapine and 120 received ritonavir-boosted lopin avir). Significantly more women in the nevirapine group reached the primary end point than in the ritonavir-boosted lopinavir group (26% vs. 8%) (adjusted P = 0.001). Virologic failure occurred in 37 (28 in the nevirapine group and 9 in the ritonavir-boosted lopinavir group), and 5 died without prior virologic failure (4 in the nevirapine group and 1 in the ritonavir-boosted lopinavir group). The group differences appeared to decrease as the interval between single-dose nevirapine exposure and the start of antiretroviral therapy increased. Retrospective bulk sequencing of baseline plasma samples showed nevirapine resistance in 33 of 239 women tested (14%). Among 500 women without prior exposure to single-dose nevirapine, 34 of 249 in the nevirapine group (14%) and 36 of 251 in the ritonavir-boosted lopinavir group (14%) had virologic failure or died. Conclusions: In women with prior exposure to peripartum single-dose nevirapine (but not in those without prior exposure), ritonavir-boosted lopinavir plus tenofovir - emtricitabine was superior to nevirapine plus tenofovir - emtricitabine for initial antiretroviral therapy. Copyright © 2010 Massachusetts Medical Society.
Authors & Co-Authors
Lockman, Shahin
Unknown Affiliation
Hughes, Michael D.
Unknown Affiliation
McIntyre, James Alasdair
Unknown Affiliation
Zheng, Yu
Unknown Affiliation
Chipato, Tsungai
Unknown Affiliation
Conradie, Francesca M.
Unknown Affiliation
Sawe, Fredrick Kipyego
Unknown Affiliation
Asmelash, Aida
Unknown Affiliation
Hosseinipour, Mina C.
Unknown Affiliation
Mohapi, Lerato
Unknown Affiliation
Stringer, Elizabeth Mc Phillips
Unknown Affiliation
Mngqibisa, Rosie
Unknown Affiliation
Siika, Abraham Mosigisi
Unknown Affiliation
Atwine, Diana
Unknown Affiliation
Hakim, James Gita
Unknown Affiliation
Shaffer, Douglas N.
Unknown Affiliation
Kanyama, Cecilia C.
Unknown Affiliation
Wools-Kaloustian, Kara K.
Unknown Affiliation
Salata, Robert A.
Unknown Affiliation
Hogg, Evelyn
Unknown Affiliation
Alston-Smith, Beverly
Unknown Affiliation
Walawander, Ann L.
Unknown Affiliation
Purcelle-Smith, E.
Unknown Affiliation
Eshleman, Susan H.
Unknown Affiliation
Rooney, James F.
Unknown Affiliation
Rahim, Sibtain
Unknown Affiliation
Mellors, John W.
Unknown Affiliation
Schooley, Robert Turner
Unknown Affiliation
Currier, Judith Silverstein
Unknown Affiliation
Statistics
Citations: 29
Authors: 29
Affiliations: 26
Identifiers
Doi:
10.1056/NEJMoa0906626
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Participants Gender
Female