Changes in plasma HIV-1-RNA viral load and CD4 cell counts, and lack of zidovudine resistance among pregnant women receiving short-course zidovudine

Ekpini, René-Anatole; Nkengasong, John N.; Sibailly, Toussaint S.; Maurice, Chantal; Adje, Christiane; Monga, Ben; Roels, Thierry H.; Greenberg, Alan E.; Wiktor, Stefan Z.

doi:10.1097/00002030-200203080-00015

Cited by 32 publications

(19 citation statements)

References 16 publications

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“…Moreover, the incidence of rash and hepatic toxicity with NVP-containing HAART, the most commonly used first-line regimen in resource-limited settings, is significantly higher in female patients with higher CD4 cell counts including during pregnancy (7,17).The second potential consequence is related to the early immunological response in HIV-infected pregnant women on HAART. Based on the above data, it appears difficult to truly appreciate the effect of HAART in the first six months of treatment initiated during pregnancy as the majority of women show an important increase in CD4+ count after delivery, even without any treatment (9). It is also likely that a decrease of the absolute CD4 count can be anticipated when women already on HAART become pregnant.…”

Section: Discussionmentioning

confidence: 99%

Variation of CD4 Count and Percentage during Pregnancy and after Delivery: Implications for HAART Initiation in Resource-Limited Settings

Ekouévi

Inwoley

Tonwe-Gold

et al. 2007

AIDS Research and Human Retroviruses

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Section: Discussionmentioning

confidence: 99%

Variation of CD4 Count and Percentage during Pregnancy and after Delivery: Implications for HAART Initiation in Resource-Limited Settings

Ekouévi

Inwoley

Tonwe-Gold

et al. 2007

AIDS Research and Human Retroviruses

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“…With regard to antiretroviral prophylaxis for the prevention of MTCT, current evidence suggests that the long-term impact in terms of future HAART regimens for women exposed to shortcourse zidovudine for the prevention of MTCT is minimal, with a low prevalence of zidovudine resistance reported [82][83][84]. However, use of singledose nevirapine is associated with high levels of usually transient maternal resistance [85,86]; the impact of such resistance on the subsequent response to ART among exposed women is under investigation; however, findings thus far indicate that use of single-dose nevirapine-boosted zidovudine prophylaxis reduces viral response to non-NRTI (NNRTI)-based ART when initiated shortly after delivery.…”

Section: Resistancementioning

confidence: 99%

Managing Mother-to-Child Transmission of HIV Infection in Developed-Country Settings

Thorne¹,

Newell²

2005

Womens Health (Lond Engl)

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This article reviews current understanding of the management of mother-to-child transmission of HIV-1 infection in the context of developed-country settings. The advent of highly active antiretroviral therapy has facilitated the virtual elimination of mother-tochild transmission of HIV infection in developed countries, reducing transmission rates to approximately 1-2%. This review describes the epidemiology of HIV infection among women of child-bearing age and the risk factors, timing and mechanisms of mother-tochild transmission, followed by a discussion of the identification of pregnant HIV-infected women and their therapeutic and obstetric management.This review will focus on the management of mother-to-child transmission (MTCT) of HIV-1 in developed-country settings. However, the vast majority of pediatric HIV infections acquired from mother to child take place in developingcountry settings, mainly in sub-Saharan Africa, which is home to 60% of people living with HIV infection worldwide. The World Health Organization (WHO) has published extensive guidelines on the use of antiretroviral drugs for treating pregnant women and preventing MTCT in resource-constrained settings [1] and on infant feeding, together with the United Nations International Children's Emergency Fund (UNICEF) and the United Nations Programme on HIV/AIDS (UNAIDS) [2]. Although evidence from clinical trials and studies in developing countries have identified effective interventions for prevention of MTCT in such settings, implementation of these and expansion of prevention of MTCT services remains a substantial challenge [3][4][5][6], as does prevention of HIV infection in women of childbearing age (Box 1).

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“…Thymidine analogue-associated mutations (TAM) conferring resistance to ZDV can occur in 0-24% when ZDV is used as monotherapy or as part of antiretroviral therapy during pregnancy. [10][11][12][13][14][15][16] Resistance to 3TC can develop rapidly due to a single point mutation at the reverse transcriptase (RT) 184 position at rates as high as 39%. 17,18 In addition, despite efficient reduction in vertical transmission, a single dose of NVP was associated with the emergence of resistant mutations in 15-65% of exposed women.…”

Section: Introductionmentioning

confidence: 99%

Persistence of Genotypic Resistance to Nelfinavir among Women Exposed to Prophylactic Antiretroviral Therapy during Pregnancy

Kakehasi

Tupinambás

Cleto

et al. 2007

AIDS Research and Human Retroviruses

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We assessed the development of drug resistance in women exposed to antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) after 24 weeks postpartum in a prospective cohort of HIV-1-infected women. HIV-1-infected women, who received prophylactic ART during pregnancy, had genotypic resistance testing performed at the start (T1) of and 24 weeks after ART interruption (T2). The women had CD4 counts Ͼ 250 cells/ml and no AIDS defining conditions. Of the 30 eligible women, the median age was 27 years [25-75% interquartile range (IQR): 21-32] and the median gestational age of ART initiation was 22 weeks (IQR: 19-27): 19 (63.3%) received zidovudine (ZDV) plus lamivudine (3TC) plus nelfinavir (NFV). At entry, most women (96.7%) were asymptomatic (CDC93 A1/A2), with a median CD4 count of 446 (IQR: 353-686) and median viral load (VL) of 8560 copies/ml (IQR: 3,252-19,515). No HIV-1 vertical transmission was observed. HIV subtype B was the most prevalent (70%). The development of new mutations associated with ART resistance was analyzed at T2. NFV resistance was observed in 4 out of 17 (23.5%) patients exposed to this drug: two major mutations D30N (1/17) and L90M (1/17) and minor mutations (N88S, 2/17). Mutations on positions 44, 69, and 118 (1/28) were present on reverse transcriptase (RT) analysis.No new nonnucleoside reverse transcriptase inhibitor (NNRTI)-associated mutation was observed. In this cohort, ART regimens were very efficient at blocking HIV vertical transmission. However, the high rate of NFV-resistant mutations observed in the postpartum period indicates the need for discussion of ART choices during pregnancy and the potential impact on future therapeutic options for these women. Women previously exposed to ART for PMTCT who will start HIV treatment should have genotypic resistance testing performed. 1515

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Changes in plasma HIV-1-RNA viral load and CD4 cell counts, and lack of zidovudine resistance among pregnant women receiving short-course zidovudine

Abstract: These findings suggest that a short course of zidovudine has no adverse HIV-1 virological consequences for the mother.

Cited by 32 publications

References 16 publications

Variation of CD4 Count and Percentage during Pregnancy and after Delivery: Implications for HAART Initiation in Resource-Limited Settings

Variation of CD4 Count and Percentage during Pregnancy and after Delivery: Implications for HAART Initiation in Resource-Limited Settings

Managing Mother-to-Child Transmission of HIV Infection in Developed-Country Settings

Persistence of Genotypic Resistance to Nelfinavir among Women Exposed to Prophylactic Antiretroviral Therapy during Pregnancy

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