Addition of 7 Days of Zidovudine Plus Lamivudine to Peripartum Single-Dose Nevirapine Effectively Reduces Nevirapine Resistance Postpartum in HIV-Infected Mothers in Malawi

作者：Farr Sherry L^*; Nelson Julie A E; Ng'ombe Thokozani J; Kourtis Athena P; Chasela Charles; Johnson Jeffrey A; Kashuba Angela D M; Tegha Gerald L; Wiener Jeffrey; Eron Joseph J; Banda Harriet N; Mpaso Mwanangwa; Lipscomb Jonathan; Matiki Chrissie; Fiscus Susan A; Jamieson Denise J; van der Horst Charles

来源：JAIDS: Journal of Acquired Immune Deficiency Syndromes , 2010, 54(5): 515-523.

DOI：10.1097/QAI.0b013e3181e3a70e

• nevirapine
• zidovudine and lamivudine
• drug resistance
• HIV
• pregnancy

Background: We assessed whether 7 days of zidovudine + lamivudine postpartum with single-dose nevirapine at labor decreases nevirapine resistance in HIV-infected women in Malawi.
Methods: HIV-infected pregnant women receiving intrapartum single-dose nevirapine and 7 days of zidovudine + lamivudine (n = 132) and women receiving intrapartum single-dose nevirapine alone (n = 66) were followed from an antenatal visit through 6 weeks postpartum. Plasma specimens at 2 and 6 weeks postpartum were tested for genotypic resistance to nevirapine by population sequencing and sensitive real-time polymerase chain reaction. Poisson regression was used to determine predictors of postpartum nevirapine resistance.
Results: Median HIV RNA was similar at entry (4.27 log vs. 4.35 log, P = 0.87), differed at 2 weeks postpartum (2.67 log vs. 3.58 log, P < 0.0001) but not at 6 weeks postpartum (4.49 log vs. 4.40 log, P = 0.79), between single-dose nevirapine/zidovudine + lamivudine and single-dose nevirapine groups, respectively. Nevirapine resistance, measured by population sequencing and sensitive real-time polymerase chain reaction, was significantly less common in those receiving single-dose nevirapine/zidovudine + lamivudine compared with single-dose nevirapine, respectively, at 2 weeks [10% (4 of 40) vs. 74% (31 of 42), P < 0.0001] and 6 weeks postpartum [10% (11 of 115) vs. 64% (41 of 64), P < 0.0001; adjusted relative risk = 0.18, 95% confidence interval (0.10 to 0.34)].
Conclusions: The significant decrease in nevirapine resistance conferred by 1 week of zidovudine + lamivudine should help policymakers optimize peripartum HIV prophylaxis recommendations.

• 出版日期2010-8-15