Response to Antiretroviral Therapy After a Single, Peripartum Dose of Nevirapine

Lockman, Shahin; Shapiro, Roger; Smeaton, Laura; Wester, Carolyn; Thior, Ibou; Stevens, Laura E.; Chand, Fatima; Makhema, Joseph; Moffat, Claire; Asmelash, Aida; Ndase, Patrick; Widenfelt, Peter Arimim Eri Van; Mazhani, Loeto; Novitsky, Vladimir; Lagakos, Stephen W.; Essex, Max

doi:10.1097/01.ogx.0000265886.39897.cb

Cited by 70 publications

(122 citation statements)

References 1 publication

Supporting

Mentioning

108

Contrasting

Unclassified

Order By: Relevance

“…The ACTG A5208 clinical trial randomized HIV-infected women to receive tenofovir/emtricitabine (TDF/FTC) plus nevirapine (NVP) or TDF/FTC plus lopinavir/ritonavir (LPV/r) with a goal of determining the impact of previous single dose NVP exposure on virologic response [12–13]. Using data from this randomized trial, we evaluated the incidence of renal events and examined if co-administration of LPV/r with TDF as a risk factor for TDF treatment discontinuation.…”

Section: Introductionmentioning

confidence: 99%

Renal events among women treated with tenofovir/emtricitabine in combination with either lopinavir/ritonavir or nevirapine

Mwafongo¹,

Nkanaunena

Zheng

et al. 2014

Aids

Self Cite

View full text Add to dashboard Cite

Objectives Tenofovir disoproxil fumarate (TDF) has been associated with renal insufficiency. Co-administration with boosted protease inhibitors (PIs), which increases its exposure, may further increase the risk of renal insufficiency. Methods We compared the incidence of renal events among women taking TDF co-administered with lopinavir/ritonavir (LPV/r) versus those co-administering TDF with nevirapine (NVP). Renal events were defined as a confirmed drop in creatinine clearance associated with a serum creatinine grade 2 or higher, or that leading to treatment modification. Results Overall, 741 HIV-infected women were enrolled into the study. Of these, 24 (3.2%) had reportable renal events (18 in LPV/r arm, 6 in NVP arm). In multivariate analysis, renal events were significantly associated with the LPV/r arm (odds ratio [OR]=3.12, 95% confidence interval [CI] 1.21, 8.05]; p=0.019), baseline HIV-1 RNA (OR=2.65, 95% CI: 1.23, 5.69 per 1 log10 copies/mL higher; p=0.013) and baseline creatinine clearance (OR=0.83, 95% CI 0.70–0.98 per 10 mL/min higher; p=0.030). In multivariate analysis evaluating renal events requiring treatment modification, only baseline HIV-1 RNA and creatinine clearance were significantly associated (OR=4.41, 95% CI 1.65, 11.78 per 1 log10 copies/mL higher; p= 0.003 and OR=0.80, 95% CI 0.64, 0.99 per 10 mL/min higher; p= 0.040, respectively). Conclusion The rates of renal events were relatively low in the two treatment arms. However, patients taking TDF co-administered with LPV/r had significantly more renal events compared to those co-administered with NVP. Furthermore, higher baseline HIV RNA and lower creatinine clearance were associated with the development of renal insufficiency requiring treatment modification.

show abstract

Section: Introductionmentioning

confidence: 99%

Renal events among women treated with tenofovir/emtricitabine in combination with either lopinavir/ritonavir or nevirapine

Mwafongo¹,

Nkanaunena

Zheng

et al. 2014

Aids

Self Cite

View full text Add to dashboard Cite

show abstract

“…The main way to prevent mother to child transmission of HIV in the developing world is a single dose of nevirapine to the mother in labour. However, nevirapine resistance may develop in some of these mothers (and children if infected) from this one dose 48. This may cause later treatment difficulties especially for those with limited access to second line drugs.…”

Section: Cart In the Developing Worldmentioning

confidence: 99%

Update on antiretroviral therapy

Riordan

Bugembe²

2009

Archives of Disease in Childhood

View full text Add to dashboard Cite

Combination antiretroviral treatment (cART) has been highly successful in preventing mother to child transmission of human immunodeficiency virus (HIV) and in reducing mortality and morbidity in HIV infected children. cART is now recommended for all HIV infected infants and selected older children. As these children will need to take cART until adulthood, the aim is to use cART with low risks of virological failure, resistance and toxicity. Since increasing numbers of antiretroviral drugs are becoming available for children, ongoing studies are needed to determine the correct doses for children, to improve adherence and to assess potential toxicity and drug interactions (such as between ritonavir and inhaled fluticasone).

show abstract

“…However, NVP-resistant virus is detected in up to 75% of women and 87% of infants following sdNVP exposure. [2][3][4] Although this resistance "fades" from detection over time, it has a negative impact upon the subsequent efficacy of treatment regimens that include NVP or other non-nucleoside reverse transcriptase inhibitors (NNRTIs), particularly when treatment is initiated within 1 to 2 years after exposure to sdNVP. [5,6] Women who took sdNVP within the previous 2 years should initiate a protease-inhibitor-containing (rather than NNRTI-containing) regimen when possible.…”

Section: Introductionmentioning

confidence: 99%

Approaches to effectively documenting prior single dose nevirapine exposure among women in Africa

Conradie

Zheng

Hosseinipour³

et al. 2012

Ann Trop Med Public Health

Self Cite

View full text Add to dashboard Cite

Background: Single dose nevirapine (sdNVP) is widely used in resource-limited settings for the prevention of mother to child transmission of HIV, but can result in NVP resistance that negatively impacts the subsequent efficacy of maternal antiretroviral therapy (ART). It is important to determine prior sdNVP exposure status to help guide treatment decisions, but systematic data on approaches to documenting previous sdNVP ingestion are lacking. Aim: With the growing body of evidence of the effects of sdNVP exposure on subsequent choices of ART, we aim to highlight some of the practical challenges that exist in documenting prior sdNVP exposure or lack thereof. Materials and Methods: ACTG A5208 Optimized Combination Therapy after Nevirapine Exposure (OCTANE) is a randomized treatment trial of protease inhibitor vs. NVP-based ART that enrolled 745 HIV-infected women in 7 African countries. Documentation of previous exposure to sdNVP (or lack thereof) was collected prospectively and intensively, as were locally-available sources of such data. Results: All 243 women who were exposed to sdNVP recalled having taken sdNVP; written documentation of sdNVP exposure was found for 73% and an additional 20% identified having ingested a NVP tablet when the tablet was shown to them. Among 502 women not exposed to sdNVP, only 10 (2%) had written documentation of lack of sdNVP exposure. NVP resistance was detected in 33 (13.8%) of sdNVP-exposed and 1 of non-exposed women. Conclusion: Maternal self-report of prior sdNVP exposure was corroborated by supporting evidence in the majority of women participating in the trial.

show abstract

Response to Antiretroviral Therapy After a Single, Peripartum Dose of Nevirapine

Cited by 70 publications

References 1 publication

Renal events among women treated with tenofovir/emtricitabine in combination with either lopinavir/ritonavir or nevirapine

Renal events among women treated with tenofovir/emtricitabine in combination with either lopinavir/ritonavir or nevirapine

Update on antiretroviral therapy

Approaches to effectively documenting prior single dose nevirapine exposure among women in Africa

Contact Info

Product

Resources

About