Antiretroviral therapies in women after single-dose nevirapine exposure

January 01, 0001

Antiretroviral therapies in women after single-dose nevirapine exposure

Peripartum administration of single-dose nevirapine reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) but selects for nevirapine-resistant virus. 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 single-dose 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.

They found: "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 lopinavir). Significantly more women in the nevirapine group reached the primary end point than in the ritonavir-boosted lopinavir group (26% vs. 8%). 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."

The authors concluded: "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."

A regimen without nevirapine is preferable for treatment of HIV/AIDS for women with prior exposure to nevirapine.

For the full abstract, click here.

N Engl J Med 363:1499-1509, 14 October 2010
© 2010 to the Massachusetts Medical Society
Antiretroviral Therapies in Women after Single-Dose Nevirapine Exposure. S. Lockman, M.D. Hughes, J. McIntyre, et al. Correspondence to Dr. Lockman:

Category: B. Blood/Blood Forming Organs/Immune Mechanisms, GH. Global Health. Keywords: HIV, women, nevirapine, peripartum prophylaxis, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 2 November 2010

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