Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine
Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine
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DOI：
10.1097/qad.0b013e32810996b2
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发表时间：
2007-05-11
期刊：
影响因子：
3.8
通讯作者：
Stringer, Jeffrey S. A.
中科院分区：
文献类型：
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作者：
Chi, Benjamin H.;Sinkala, Moses;Stringer, Jeffrey S. A.
目的：为了确定是否以前暴露于单剂量奈韦拉平（NVP）预防母婴艾滋病毒传播（PMTCT）与衰减的CD 4细胞反应，死亡，或临床治疗失败的妇女开始抗逆转录病毒治疗（ART）含有非核苷类逆转录酶抑制剂（NNRTI）。方法：开放队列评估结果的妇女在赞比亚各地的计划网站。根据赞比亚/世界卫生组织guidelines.Results：围产期NVP暴露状态已知6740名妇女启动含NNRTI的ART，其中751（11%）报告以前使用NVP的PMTCT。在6个月（+202 vs.+182 cells/mu l; P=0.20）或12个月（+201 vs.+211 cells/mu l; P=0.60）时，暴露于或未暴露于NVP的受试者之间的平均CD 4细胞变化无显著差异。多变量分析显示死亡率[校正的风险比（HR），1.2; 95%置信区间（CI），0.8-1.8]或临床治疗失败（校正的HR，1.1; 95% CI，0.8-1.5）无显著差异。近期NVP暴露与远程暴露的比较表明，在6个月（+150 vs +219细胞/μ l; P=0.06）和12个月（+149 vs +215细胞/μ l; P=0.39）时，CD 4细胞应答较差。近期接触NVP的女性也有临床治疗失败风险升高的趋势（调整后的HR，1.6; 95%CI，0.9-2.7）。结论：接触母体单剂量NVP与显著不同的短期治疗结果无关。然而，有证据表明，在开始ART治疗后6个月内暴露可能是治疗结果不佳的风险因素，突出了ART筛查和妊娠早期开始的重要性。(C)2007年利平科特威廉姆斯&威尔金斯。
Objective: To determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response, death, or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI).Methods: Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines.Results: Peripartum NVP exposure status was known for 6740 women initiating NNRTI-containing ART, of whom 751 (11%) reported prior use of NVP for PMTCT. There was no significant difference in mean CD4 cell change between those exposed or unexposed to NVP at 6 (+202 versus +182 cells/mu l; P=0.20) or 12 (+201 versus +211 cells/mu l; P=0.60) months. Multivariable analyses showed no significant differences in mortality [adjusted hazard ratio (HR), 1.2; 95% confidence interval (CI), 0.8-1.8] or clinical treatment failure (adjusted HR, 1.1; 95% CI, 0.8-1.5). Comparison of recent NVP exposure with remote exposure suggested a less favorable CD4 cell response at 6 (+150 versus +219cells/mu l; P=0.06) and 12 (+149 versus +215 cells/mu l; P=0.39) months. Women with recent NVP exposure also had a trend towards elevated risk for clinical treatment failure (adjusted HR, 1.6; 95% CI, 0.9-2.7).Conclusion: Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes. However, evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes, highlighting the importance of ART screening and initiation early in pregnancy. (C) 2007 Lippincott Williams & Wilkins.