Maternal 12-month response to antiretroviral therapy following prevention of mother-to-child transmission of HIV type 1, Ivory Coast, 2003-2006
Maternal 12-month response to antiretroviral therapy following prevention of mother-to-child transmission of HIV type 1, Ivory Coast, 2003-2006
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DOI：
10.1086/526780
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发表时间：
2008-02-15
影响因子：
11.8
通讯作者：
Dabis, Francois
中科院分区：
文献类型：
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作者：
Coffie, Patrick A.;Ekouevi, Didier K.;Dabis, Francois
Objective.我们的目的是研究暴露于单剂量奈韦拉平（NVP）和/或短程齐多夫定（ZDV;联合或不联合拉米夫定[3 TC]）以预防人类免疫缺陷病毒（HIV）感染母婴传播的妇女对抗逆转录病毒治疗的反应。所有开始使用司他夫定或ZDV、3 TC和NVP或依法韦仑进行抗逆转录病毒治疗的HIV 1型感染妇女都有资格参加科特迪瓦阿比让的MTCT+项目。暴露女性在既往妊娠期间接受过单剂量NVP或短程ZDV（伴或不伴3 TC）加单剂量NVP。在分娩后第4周进行基因型耐药性检测。病毒学失败定义为开始抗逆转录病毒治疗后12个月血浆HIV RNA水平1500拷贝/mL。在接受抗逆转录病毒治疗的247名妇女中，109名（44%）未暴露; 81名接受了短程ZDV +3 TC以及单剂量NVP; 5名接受了短程ZDV +3 TC; 50名接受了短程ZDV+单剂量NVP; 2名仅接受了单剂量NVP。在115名样本可用于基因型检测的妇女中未检测到ZDV突变; 73名分娩后检测的3 TC暴露妇女中有11名（15.1%）有3 TC耐药突变。暴露于短程ZDV和3 TC加单剂量NVP的69名妇女中有3名（4.3%）和暴露于短程ZDV加单剂量NVP的42名妇女中有16名（38.1%）有NVP耐药突变。干预后开始抗逆转录病毒治疗的时间中位数为21个月，以防止母婴HIV传播（中位数CD 4（+）T淋巴细胞计数，188个细胞/mm（3））。在42例患者中确定了第12个月的病毒学失败（19.2%）的219名妇女的数据，多变量分析显示，它与治疗依从性差（校正比值比[aOR]，12.7; 95%置信区间[CI]，3.0-53.9），产后3 TC耐药突变（aOR，6.9; 95% CI，1.1-42.9），和基线CD 4 + T淋巴细胞计数
Objective. Our aim was to study the response to antiretroviral treatment among women exposed to single-dose nevirapine (NVP) and/or short-course zidovudine (ZDV; with or without lamivudine [3TC]) for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) infection.Methods. All HIV type 1-infected women who initiated antiretroviral treatment with stavudine or ZDV, 3TC, and NVP or efavirenz were eligible for the MTCT-Plus program in Abidjan, Ivory Coast. Exposed women had received either single-dose NVP alone or short-course ZDV (with or without 3TC) plus single-dose NVP during previous pregnancy. Genotypic resistance testing was performed at week 4 after delivery. Virologic failure was defined as a plasma HIV RNA level 1500 copies/mL 12 months after initiation of antiretroviral treatment.Results. Among 247 women who received antiretroviral treatment, 109 (44%) were unexposed; 81 had received short-course ZDV with 3TC, as well as single-dose NVP; 5 had received short-course ZDV plus 3TC; 50 had received short-course ZDV plus single-dose NVP; and 2 had received single-dose NVP alone. No ZDV mutation was detected in the 115 women whose specimens were available for genotypic testing; 11 (15.1%) of 73 women with 3TC exposure who were tested after delivery had 3TC resistance mutations. Three (4.3%) of 69 women exposed to short-course ZDV and 3TC plus single-dose NVP and 16 (38.1%) of 42 women exposed to short-course ZDV plus single-dose NVP had NVP resistance mutations. Antiretroviral treatment was initiated a median of 21 months after the intervention to prevent mother-to-child HIV transmission (median CD4(+) T lymphocyte count, 188 cells/mm(3)). Month 12 virologic failure was identified in 42 (19.2%) of 219 women for whom data were available, and multivariate analysis revealed that it was associated with poor adherence to treatment (adjusted odds ratio [aOR], 12.7; 95% confidence interval [CI], 3.0-53.9), postpartum 3TC resistance mutations (aOR, 6.9; 95% CI, 1.1-42.9), and a baseline CD4+ T lymphocyte count