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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine
AIDS, Volume 21, No. 8, Year 2007
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Description
OBJECTIVE: To determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response, death, or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI). METHODS: Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines. RESULTS: Peripartum NVP exposure status was known for 6740 women initiating NNRTI-containing ART, of whom 751 (11%) reported prior use of NVP for PMTCT. There was no significant difference in mean CD4 cell change between those exposed or unexposed to NVP at 6 (+202 versus +182 cells/μl; P = 0.20) or 12 (+201 versus +211 cells/μl; P = 0.60) months. Multivariable analyses showed no significant differences in mortality [adjusted hazard ratio (HR), 1.2; 95% confidence interval (CI), 0.8-1.8] or clinical treatment failure (adjusted HR, 1.1; 95% CI, 0.8-1.5). Comparison of recent NVP exposure with remote exposure suggested a less favorable CD4 cell response at 6 (+150 versus +219 cells/μl; P = 0.06) and 12 (+149 versus +215 cells/μl; P = 0.39) months. Women with recent NVP exposure also had a trend towards elevated risk for clinical treatment failure (adjusted HR, 1.6; 95% CI, 0.9-2.7). CONCLUSION: Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes. However, evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes, highlighting the importance of ART screening and initiation early in pregnancy. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Chi, Benjamin H.
Zambia, Lusaka
University of Zambia
United States, Birmingham
The University of Alabama at Birmingham
Sinkala, Moses M.
Zambia, Lusaka
University of Zambia
Stringer, Elizabeth Mc Phillips
Zambia, Lusaka
University of Zambia
United States, Birmingham
The University of Alabama at Birmingham
Cantrell, Ronald A.
Zambia, Lusaka
University of Zambia
United States, Birmingham
The University of Alabama at Birmingham
Mtonga, Velepi
Zambia, Lusaka
University of Zambia
Bulterys, Marc G.
Zambia, Lusaka
University of Zambia
Zulu, Isaac S.
Zambia, Lusaka
University of Zambia
Zambia, Lusaka
University of Zambia School of Medicine
Kankasa, Chipepo
Zambia, Lusaka
University Teaching Hospital Lusaka
Wilfert, Catherine M.
United States, Washington, D.c.
Elizabeth Glaser Pediatric Aids Foundation
Weidle, Paul J.
United States, Atlanta
Centers for Disease Control and Prevention
Vermund, Sten Havlor
Zambia, Lusaka
University of Zambia
United States, Nashville
Vanderbilt University School of Medicine
Stringer, Jeffrey S.A.
Zambia, Lusaka
University of Zambia
United States, Birmingham
The University of Alabama at Birmingham
Statistics
Citations: 74
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1097/QAD.0b013e32810996b2
Research Areas
Environmental
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Zambia
Participants Gender
Female