Journal Article

Maternal 12-Month Response to Antiretroviral Therapy following Prevention of Mother-to-Child Transmission of HIV Type 1, Ivory Coast, 2003– 2006

Patrick A. Coffie, Didier K. Ekouevi, Marie-Laure Chaix, Besigin Tonwe-Gold, Amani-Bosse Clarisse, Renaud Becquet, Ida Viho, Therese N' dri-Yoman, Valé riane Leroy, Elaine J. Abrams, Christine Rouzioux and Franç ois Dabis

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 4, pages 611-621
Published in print February 2008 | ISSN: 1058-4838
Published online February 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/526780
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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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 >500 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/mm3). 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 < 200 cells/mm3 (aOR, 0.3; 95% CI, 0.2– 0.8). NVP resistance was not associated with virological failure (aOR, 1.8; 95% CI, 0.5– 6.5).

Conclusions. Our study found that poor adherence and 3TC resistance acquired after the intervention to prevent mother-to-child transmission of HIV infection were associated with virologic failure in women who initiated antiretroviral treatment.

Journal Article.  5166 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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