Effectiveness of repeat single-dose nevirapine for prevention of mother-to-child transmission of HIV-1 in repeat pregnancies in Uganda

Michelle S. McConnell, Paul Bakaki, Chineta Eure, Michael Mubiru, Danstan Bagenda, Robert Downing, Flavia Matovu, Michael C. Thigpen, Alan E. Greenberg, Mary Glenn Fowler

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Single-dose nevirapine (SDNVP) is widely used to prevent mother-to-child HIV transmission in resource-limited settings. Given detection of resistant mutants among women who receive SDNVP, concerns have arisen over the efficacy of SDNVP in repeat pregnancies. METHODS: Retrospective data were collected from SDNVP-exposed and -unexposed women from the HIV Network for Prevention 012 trial who subsequently received SDNVP in another pregnancy. Prospective data were collected from pregnant women who were SDNVP exposed or unexposed before delivery. Kaplan-Meier and Cox regression analyses were used to estimate rates of HIV infection and HIV-free survival among infants born to women with or without prior SDNVP exposure. RESULTS: In the retrospective cohort, the infection rates were 11.3% and 16.7% for 104 infants of NVP-exposed and -unexposed mothers, respectively (P = 0.41). In the prospective cohort, among 103 infants of NVP-exposed and -unexposed mothers, the 12-month infant HIV infection rates were 20.5% and 18.7% (P = 0.81) and HIV-free survival rates were 74.4% and 78.1% (P = 0.66), respectively. CONCLUSIONS: There was no increased risk of infant HIV infection among SDNVP-exposed women compared with -unexposed women. These findings support current international guidelines to offer SDNVP to HIV-infected pregnant women, regardless of previous SDNVP exposure, when more complex prophylaxis regimens are not available.

Original languageEnglish (US)
Pages (from-to)291-296
Number of pages6
JournalJournal of Acquired Immune Deficiency Syndromes
Volume46
Issue number3
DOIs
StatePublished - Nov 2007
Externally publishedYes

Fingerprint

Nevirapine
Uganda
HIV-1
Mothers
Pregnancy
HIV
HIV Infections
Pregnant Women
Survival Rate
Regression Analysis
Guidelines

Keywords

  • HIV transmission
  • Nevirapine
  • Perinatal HIV infection
  • Resistance

ASJC Scopus subject areas

  • Virology
  • Immunology

Cite this

Effectiveness of repeat single-dose nevirapine for prevention of mother-to-child transmission of HIV-1 in repeat pregnancies in Uganda. / McConnell, Michelle S.; Bakaki, Paul; Eure, Chineta; Mubiru, Michael; Bagenda, Danstan; Downing, Robert; Matovu, Flavia; Thigpen, Michael C.; Greenberg, Alan E.; Fowler, Mary Glenn.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 46, No. 3, 11.2007, p. 291-296.

Research output: Contribution to journalArticle

McConnell, Michelle S. ; Bakaki, Paul ; Eure, Chineta ; Mubiru, Michael ; Bagenda, Danstan ; Downing, Robert ; Matovu, Flavia ; Thigpen, Michael C. ; Greenberg, Alan E. ; Fowler, Mary Glenn. / Effectiveness of repeat single-dose nevirapine for prevention of mother-to-child transmission of HIV-1 in repeat pregnancies in Uganda. In: Journal of Acquired Immune Deficiency Syndromes. 2007 ; Vol. 46, No. 3. pp. 291-296.
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abstract = "BACKGROUND: Single-dose nevirapine (SDNVP) is widely used to prevent mother-to-child HIV transmission in resource-limited settings. Given detection of resistant mutants among women who receive SDNVP, concerns have arisen over the efficacy of SDNVP in repeat pregnancies. METHODS: Retrospective data were collected from SDNVP-exposed and -unexposed women from the HIV Network for Prevention 012 trial who subsequently received SDNVP in another pregnancy. Prospective data were collected from pregnant women who were SDNVP exposed or unexposed before delivery. Kaplan-Meier and Cox regression analyses were used to estimate rates of HIV infection and HIV-free survival among infants born to women with or without prior SDNVP exposure. RESULTS: In the retrospective cohort, the infection rates were 11.3{\%} and 16.7{\%} for 104 infants of NVP-exposed and -unexposed mothers, respectively (P = 0.41). In the prospective cohort, among 103 infants of NVP-exposed and -unexposed mothers, the 12-month infant HIV infection rates were 20.5{\%} and 18.7{\%} (P = 0.81) and HIV-free survival rates were 74.4{\%} and 78.1{\%} (P = 0.66), respectively. CONCLUSIONS: There was no increased risk of infant HIV infection among SDNVP-exposed women compared with -unexposed women. These findings support current international guidelines to offer SDNVP to HIV-infected pregnant women, regardless of previous SDNVP exposure, when more complex prophylaxis regimens are not available.",
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AU - McConnell, Michelle S.

AU - Bakaki, Paul

AU - Eure, Chineta

AU - Mubiru, Michael

AU - Bagenda, Danstan

AU - Downing, Robert

AU - Matovu, Flavia

AU - Thigpen, Michael C.

AU - Greenberg, Alan E.

AU - Fowler, Mary Glenn

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N2 - BACKGROUND: Single-dose nevirapine (SDNVP) is widely used to prevent mother-to-child HIV transmission in resource-limited settings. Given detection of resistant mutants among women who receive SDNVP, concerns have arisen over the efficacy of SDNVP in repeat pregnancies. METHODS: Retrospective data were collected from SDNVP-exposed and -unexposed women from the HIV Network for Prevention 012 trial who subsequently received SDNVP in another pregnancy. Prospective data were collected from pregnant women who were SDNVP exposed or unexposed before delivery. Kaplan-Meier and Cox regression analyses were used to estimate rates of HIV infection and HIV-free survival among infants born to women with or without prior SDNVP exposure. RESULTS: In the retrospective cohort, the infection rates were 11.3% and 16.7% for 104 infants of NVP-exposed and -unexposed mothers, respectively (P = 0.41). In the prospective cohort, among 103 infants of NVP-exposed and -unexposed mothers, the 12-month infant HIV infection rates were 20.5% and 18.7% (P = 0.81) and HIV-free survival rates were 74.4% and 78.1% (P = 0.66), respectively. CONCLUSIONS: There was no increased risk of infant HIV infection among SDNVP-exposed women compared with -unexposed women. These findings support current international guidelines to offer SDNVP to HIV-infected pregnant women, regardless of previous SDNVP exposure, when more complex prophylaxis regimens are not available.

AB - BACKGROUND: Single-dose nevirapine (SDNVP) is widely used to prevent mother-to-child HIV transmission in resource-limited settings. Given detection of resistant mutants among women who receive SDNVP, concerns have arisen over the efficacy of SDNVP in repeat pregnancies. METHODS: Retrospective data were collected from SDNVP-exposed and -unexposed women from the HIV Network for Prevention 012 trial who subsequently received SDNVP in another pregnancy. Prospective data were collected from pregnant women who were SDNVP exposed or unexposed before delivery. Kaplan-Meier and Cox regression analyses were used to estimate rates of HIV infection and HIV-free survival among infants born to women with or without prior SDNVP exposure. RESULTS: In the retrospective cohort, the infection rates were 11.3% and 16.7% for 104 infants of NVP-exposed and -unexposed mothers, respectively (P = 0.41). In the prospective cohort, among 103 infants of NVP-exposed and -unexposed mothers, the 12-month infant HIV infection rates were 20.5% and 18.7% (P = 0.81) and HIV-free survival rates were 74.4% and 78.1% (P = 0.66), respectively. CONCLUSIONS: There was no increased risk of infant HIV infection among SDNVP-exposed women compared with -unexposed women. These findings support current international guidelines to offer SDNVP to HIV-infected pregnant women, regardless of previous SDNVP exposure, when more complex prophylaxis regimens are not available.

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