6-month Immunological Response with HAART-containing Nevirapine in HIV Positive Women Post-exposure to Single-dose of Nevirapine for PMTCT

Single-dose nevirapine (sdNVP) is known to induce viral resistance when used to prevent mother-to-child of HIV-1 transmission (PMTCT). In resource-limited settings NNRTI based HAART, using NVP, is the WHO-recommended first-line regimen for adults.

In this study, researchers evaluate the immunological response in women treated with NVP-based HAART according to their previous exposure to sdNVP (sdNVP+) for PMTCT in Abidjan.

MTCT-Plus is a multi-country care and treatment program built upon existing PMTCT services. It provides pregnant and postpartum women, their partners and children with family-centered HIV care including HAART when they meet WHO eligibility criteria (WHO stage 4, stage 2 or 3 with CD4 count <350/mm3 and CD4<200/mm3).

Results

·   From August 2003 to February 2005, 530 women were enrolled and 209 HIV-infected women including 92 (44%) pregnant women were initiated HAART.

·   Among these women, 115 (55%) had received previously sdNVP for PMTCT including 49 with ZDV and 66 with ZDV+3TC.

·   The delay in median between PMTCT intervention and HAART initiation was 19 months.

·    The median CD4 count was 191/mm3.

·   The first-line regimens initiated by the women were ZDV+3TC+NVP (93%), D4T+3TC+NVP (3%) and other regimens (4%).

·   Median follow-up on HAART was 7.5 months. At 6 months on treatment, the CD4 count increased in median by 205 cells/mm3; IQR [125-313/mm3] in 127 women who had measurements available.

·   No statistical difference in CD4 count was found between the 64 women sdNVP+ and the 63 women sdNVP- (189/mm3 vs 222/mm3, p=0.53). At 12 months, the CD4 count increased in median of 307/mm3 [188-451] in women sdNVP+ (n=15) and 289/mm3 [161-364] (n=27) in women sdNVP- (p=0.37).

The authors conclude, “The 6-month immunological response was similar in women previously exposed or not to sdNVP before initiating HAART. Further follow-up is necessary to fully assess the long-term, impact of sdNVP used for PMTCT on the success of NNRTI containing therapeutic regimens.”

Programme MTCT-Plus, Aconda, Abidjan, Côte D'Ivoire, Unité INSERM 593, Institut De Santé Publique, Epidémiologie Et Développement (ISPED), Bordeaux, France, The MTCT-Plus Initiative, Mailman School Of Public Healths, Columbia University, New-York, United States of America.

08/03/05

Reference
G Bedikou and others. 6-month immunological response with HAART containing Nevirapine in HIV infected women post exposure to single dose of Nevirapine for PMTCT. The MTCT-Plus Initiave in Abidjan, Côte d’Ivoire (2003-2005). 3^rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro, Brazil.

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