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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Women exposed to single-dose nevirapine in successive pregnancies: Effectiveness and nonnucleoside reverse transcriptase inhibitor resistance
AIDS, Volume 23, No. 7, Year 2009
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Description
Objective: To assess the impact of prior exposure to single-dose nevirapine (sdNVP) on mother-to-child transmission and genotypic resistance in HIV-infected women. Design: Prospective study of 120 women exposed to the HIVNET012 sdNVP regimen in two successive pregnancies and 240 antiretroviral (ARV)-nai've, multiparous women who received sdNVP for the first time. Results: One hundred and eight of 120 and 193 of 240 women returned for a postpartum visit by 6 weeks. HIV-1 was detected in 11.1% (95% confidence interval = 5.9-18.6) of the infants of women previously exposed to sdNVP and 4.2% (95% confidence interval = 1.3-7.0) of those exposed for the first time (P = 0.028). Rates of maternal HIV-1 genotypic resistance at 6 weeks postdelivery were 37.5% and 46.4%, respectively (P = 0.119). Sensitive mutation-specific real-time PCR testing found three of 12 previously exposed women who transmitted HIV-1 to their infants had either K103N or Y181C at baseline compared with one of eight ARV-naTve, transmitting women who had Y181C. None of 40 randomly selected nontransmitting women from either group had detectable NVP resistance mutations prior to sdNVP exposure. Conclusion: This study shows that effectiveness of sdNVP may be compromised by prior exposure to sdNVP, although the increase in transmission rate after prior exposure could not be explained by the detection of NVP resistance mutations prior to re-exposure as measured both by standard genotyping and highly sensitive allele- specific PCR assays. Furthermore, transmission rates of women with prior exposure were not higher than those reported elsewhere. © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Martinson, Neil Alexander
United States, Baltimore
School of Medicine
South Africa, Johannesburg
University of the Witwatersrand
South Africa, Johannesburg
Perinatal Hiv Research Unit
Morris, Lynn
South Africa, Johannesburg
National Institute for Communicable Diseases
Johnson, Jeffrey
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Gray, Glenda E.
South Africa, Johannesburg
University of the Witwatersrand
Pillay, Visva
South Africa, Johannesburg
National Institute for Communicable Diseases
Ledwaba, Johanna
South Africa, Johannesburg
National Institute for Communicable Diseases
Dhlamini, Puleng
South Africa, Johannesburg
University of the Witwatersrand
Cohen, Sarah
South Africa, Johannesburg
National Institute for Communicable Diseases
Puren, Adrian
South Africa, Johannesburg
National Institute for Communicable Diseases
Steyn, Jan G.
South Africa, Johannesburg
University of the Witwatersrand
Heneine, Walid M.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
McIntyre, James Alasdair
South Africa, Johannesburg
University of the Witwatersrand
Statistics
Citations: 24
Authors: 12
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e328323ad49
e-ISSN:
14735571
Research Areas
Cancer
Genetics And Genomics
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Participants Gender
Female