Addition of 7 Days of Zidovudine plus Lamivudine to Peripartum Single-Dose Nevirapine Effectively Reduces Nevirapine Resistance Postpartum in HIV-Infected Mothers in Malawi

Citation

Farr, Sherry L.; Nelson, Julie A. E.; Ng'ombe, Thokozani J.; Kourtis, Athena P.; Chasela, Charles S.; Johnson, Jeffrey A.; Kashuba, Angela; Tegha, Gerald; Wiener, Jeffrey B.; & Eron, Joseph J., Jr., et al. (2010). 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, 54(5), 515-523. PMCID: PMC2913302

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.

URL

http://dx.doi.org/10.1097/QAI.0b013e3181e3a70e

Reference Type

Journal Article

Year Published

2010

Journal Title

Journal of Acquired Immune Deficiency Syndromes

Author(s)

Farr, Sherry L.
Nelson, Julie A. E.
Ng'ombe, Thokozani J.
Kourtis, Athena P.
Chasela, Charles S.
Johnson, Jeffrey A.
Kashuba, Angela
Tegha, Gerald
Wiener, Jeffrey B.
Eron, Joseph J., Jr.
Banda, Harriet N.
Mpaso, Mwanangwa
Lipscomb, Jonathan
Matiki, Chrissie
Fiscus, Susan A.
Jamieson, Denise J.
van der Horst, Charles M., for the UNC Project BAN Study Team [
Linda S. Adair and Margaret E. Bentley, Members
]

PMCID

PMC2913302