Antiretroviral Therapies in Women after Single-Dose Nevirapine Exposure
| Autor: | Shahin, Lockman, Michael D, Hughes, James, McIntyre, Yu, Zheng, Tsungai, Chipato, Francesca, Conradie, Fred, Sawe, Aida, Asmelash, Mina C, Hosseinipour, Lerato, Mohapi, Elizabeth, Stringer, Rosie, Mngqibisa, Abraham, Siika, Diana, Atwine, James, Hakim, Douglas, Shaffer, Cecilia, Kanyama, Kara, Wools-Kaloustian, Robert A, Salata, Evelyn, Hogg, Beverly, Alston-Smith, Ann, Walawander, Eva, Purcelle-Smith, Susan, Eshleman, James, Rooney, Sibtain, Rahim, John W, Mellors, Robert T, Schooley, Judith S, Currier, Bola, Adedeji |
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| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
medicine.medical_specialty Nevirapine Anti-HIV Agents Organophosphonates HIV Infections Kaplan-Meier Estimate Pyrimidinones Deoxycytidine Lopinavir Statistics Nonparametric Article Young Adult Pharmacotherapy Acquired immunodeficiency syndrome (AIDS) Pregnancy immune system diseases Internal medicine medicine Emtricitabine Humans Treatment Failure Pregnancy Complications Infectious Tenofovir Sida Ritonavir Reverse-transcriptase inhibitor biology business.industry Adenine virus diseases General Medicine medicine.disease biology.organism_classification Virology Infectious Disease Transmission Vertical CD4 Lymphocyte Count Anti-Retroviral Agents HIV-1 Linear Models Drug Therapy Combination Female Viral disease business Follow-Up Studies medicine.drug |
| Popis: | 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.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%) (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.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. (Funded by the National Institute of Allergy and Infectious Diseases and the National Research Center; ClinicalTrials.gov number, NCT00089505.). |
| Databáze: | OpenAIRE |
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