Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine

Peter K. Mudiope, Soyeon Kim, Deo Wabwire, Louis Nyende, Danstan Bagenda, Mike Mubiru, Robinah Mulira, Sawsan Elbireer, Zikulah Namukwaya, Mary Glenn Fowler, Philippa Musoke

Research output: Contribution to journalArticle

Abstract

Objectives: To determine and compare the clinical and immunologic outcomes for HIV-infected women initiated on antiretroviral therapy (ART), with and without previous exposure to single-dose nevirapine in the MTCT-Plus programme - Kampala, Uganda, from 2003 to 2011. Methods: Retrospective comparison of prospectively collected programmatic data of clinical and immunologic treatment outcomes among HIV-infected Ugandan women, with and without prior exposure to sdNVP, who received NNRTI-based ART for a median follow-up of 6 years. Results: Of the 408 women in the programme, 289 (70.8%) were started on ART, of whom 205 (70.9%) had prior exposure to sdNVP. Clinical, immunologic and combined (clinical and or immunologic) treatment failure occurred in 29 (10.0%), 132 (45.7%) and 142 (49.1%) women, respectively. There was no significant difference in the distribution of time to immunologic failure for women by exposure to sdNVP (log-rank P = 0.98). In Cox proportional hazard modelling, exposure to sdNVP was not associated with immunologic failure [adjusted hazard ratio (HR) = 0.89, 95% confidence interval (CI): 0.61-1.30]. CD4 count >100 cells/mm3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95% CI: 0.22-0.48). Conclusions: HIV-infected Ugandan women initiated on an NVP-based ART regimen had similar immunologic treatment outcomes irrespective of previous NVP exposure. CD4 cell count prior to initiating HAART was a key prognostic factor for successful long-term immunologic treatment outcomes. In poor settings, regular follow-up of patients on HAART with adequate counselling to promote adherence and safe disclosure may promote low clinical failure rates.

Original languageEnglish (US)
Pages (from-to)344-351
Number of pages8
JournalTropical Medicine and International Health
Volume18
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Nevirapine
HIV
Highly Active Antiretroviral Therapy
CD4 Lymphocyte Count
Confidence Intervals
Uganda
Disclosure
Therapeutics
Treatment Failure
Counseling
Incidence

Keywords

  • HIV treatment
  • Nevirapine-exposed
  • Outcomes
  • Uganda
  • Women

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases
  • Parasitology

Cite this

Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine. / Mudiope, Peter K.; Kim, Soyeon; Wabwire, Deo; Nyende, Louis; Bagenda, Danstan; Mubiru, Mike; Mulira, Robinah; Elbireer, Sawsan; Namukwaya, Zikulah; Fowler, Mary Glenn; Musoke, Philippa.

In: Tropical Medicine and International Health, Vol. 18, No. 3, 03.2013, p. 344-351.

Research output: Contribution to journalArticle

Mudiope, PK, Kim, S, Wabwire, D, Nyende, L, Bagenda, D, Mubiru, M, Mulira, R, Elbireer, S, Namukwaya, Z, Fowler, MG & Musoke, P 2013, 'Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine', Tropical Medicine and International Health, vol. 18, no. 3, pp. 344-351. https://doi.org/10.1111/tmi.12054
Mudiope, Peter K. ; Kim, Soyeon ; Wabwire, Deo ; Nyende, Louis ; Bagenda, Danstan ; Mubiru, Mike ; Mulira, Robinah ; Elbireer, Sawsan ; Namukwaya, Zikulah ; Fowler, Mary Glenn ; Musoke, Philippa. / Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine. In: Tropical Medicine and International Health. 2013 ; Vol. 18, No. 3. pp. 344-351.
@article{ddcd77323c3b4c0996e860b88d1e5186,
title = "Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine",
abstract = "Objectives: To determine and compare the clinical and immunologic outcomes for HIV-infected women initiated on antiretroviral therapy (ART), with and without previous exposure to single-dose nevirapine in the MTCT-Plus programme - Kampala, Uganda, from 2003 to 2011. Methods: Retrospective comparison of prospectively collected programmatic data of clinical and immunologic treatment outcomes among HIV-infected Ugandan women, with and without prior exposure to sdNVP, who received NNRTI-based ART for a median follow-up of 6 years. Results: Of the 408 women in the programme, 289 (70.8{\%}) were started on ART, of whom 205 (70.9{\%}) had prior exposure to sdNVP. Clinical, immunologic and combined (clinical and or immunologic) treatment failure occurred in 29 (10.0{\%}), 132 (45.7{\%}) and 142 (49.1{\%}) women, respectively. There was no significant difference in the distribution of time to immunologic failure for women by exposure to sdNVP (log-rank P = 0.98). In Cox proportional hazard modelling, exposure to sdNVP was not associated with immunologic failure [adjusted hazard ratio (HR) = 0.89, 95{\%} confidence interval (CI): 0.61-1.30]. CD4 count >100 cells/mm3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95{\%} CI: 0.22-0.48). Conclusions: HIV-infected Ugandan women initiated on an NVP-based ART regimen had similar immunologic treatment outcomes irrespective of previous NVP exposure. CD4 cell count prior to initiating HAART was a key prognostic factor for successful long-term immunologic treatment outcomes. In poor settings, regular follow-up of patients on HAART with adequate counselling to promote adherence and safe disclosure may promote low clinical failure rates.",
keywords = "HIV treatment, Nevirapine-exposed, Outcomes, Uganda, Women",
author = "Mudiope, {Peter K.} and Soyeon Kim and Deo Wabwire and Louis Nyende and Danstan Bagenda and Mike Mubiru and Robinah Mulira and Sawsan Elbireer and Zikulah Namukwaya and Fowler, {Mary Glenn} and Philippa Musoke",
year = "2013",
month = "3",
doi = "10.1111/tmi.12054",
language = "English (US)",
volume = "18",
pages = "344--351",
journal = "Tropical Medicine and International Health",
issn = "1360-2276",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine

AU - Mudiope, Peter K.

AU - Kim, Soyeon

AU - Wabwire, Deo

AU - Nyende, Louis

AU - Bagenda, Danstan

AU - Mubiru, Mike

AU - Mulira, Robinah

AU - Elbireer, Sawsan

AU - Namukwaya, Zikulah

AU - Fowler, Mary Glenn

AU - Musoke, Philippa

PY - 2013/3

Y1 - 2013/3

N2 - Objectives: To determine and compare the clinical and immunologic outcomes for HIV-infected women initiated on antiretroviral therapy (ART), with and without previous exposure to single-dose nevirapine in the MTCT-Plus programme - Kampala, Uganda, from 2003 to 2011. Methods: Retrospective comparison of prospectively collected programmatic data of clinical and immunologic treatment outcomes among HIV-infected Ugandan women, with and without prior exposure to sdNVP, who received NNRTI-based ART for a median follow-up of 6 years. Results: Of the 408 women in the programme, 289 (70.8%) were started on ART, of whom 205 (70.9%) had prior exposure to sdNVP. Clinical, immunologic and combined (clinical and or immunologic) treatment failure occurred in 29 (10.0%), 132 (45.7%) and 142 (49.1%) women, respectively. There was no significant difference in the distribution of time to immunologic failure for women by exposure to sdNVP (log-rank P = 0.98). In Cox proportional hazard modelling, exposure to sdNVP was not associated with immunologic failure [adjusted hazard ratio (HR) = 0.89, 95% confidence interval (CI): 0.61-1.30]. CD4 count >100 cells/mm3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95% CI: 0.22-0.48). Conclusions: HIV-infected Ugandan women initiated on an NVP-based ART regimen had similar immunologic treatment outcomes irrespective of previous NVP exposure. CD4 cell count prior to initiating HAART was a key prognostic factor for successful long-term immunologic treatment outcomes. In poor settings, regular follow-up of patients on HAART with adequate counselling to promote adherence and safe disclosure may promote low clinical failure rates.

AB - Objectives: To determine and compare the clinical and immunologic outcomes for HIV-infected women initiated on antiretroviral therapy (ART), with and without previous exposure to single-dose nevirapine in the MTCT-Plus programme - Kampala, Uganda, from 2003 to 2011. Methods: Retrospective comparison of prospectively collected programmatic data of clinical and immunologic treatment outcomes among HIV-infected Ugandan women, with and without prior exposure to sdNVP, who received NNRTI-based ART for a median follow-up of 6 years. Results: Of the 408 women in the programme, 289 (70.8%) were started on ART, of whom 205 (70.9%) had prior exposure to sdNVP. Clinical, immunologic and combined (clinical and or immunologic) treatment failure occurred in 29 (10.0%), 132 (45.7%) and 142 (49.1%) women, respectively. There was no significant difference in the distribution of time to immunologic failure for women by exposure to sdNVP (log-rank P = 0.98). In Cox proportional hazard modelling, exposure to sdNVP was not associated with immunologic failure [adjusted hazard ratio (HR) = 0.89, 95% confidence interval (CI): 0.61-1.30]. CD4 count >100 cells/mm3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95% CI: 0.22-0.48). Conclusions: HIV-infected Ugandan women initiated on an NVP-based ART regimen had similar immunologic treatment outcomes irrespective of previous NVP exposure. CD4 cell count prior to initiating HAART was a key prognostic factor for successful long-term immunologic treatment outcomes. In poor settings, regular follow-up of patients on HAART with adequate counselling to promote adherence and safe disclosure may promote low clinical failure rates.

KW - HIV treatment

KW - Nevirapine-exposed

KW - Outcomes

KW - Uganda

KW - Women

UR - http://www.scopus.com/inward/record.url?scp=84873987379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873987379&partnerID=8YFLogxK

U2 - 10.1111/tmi.12054

DO - 10.1111/tmi.12054

M3 - Article

VL - 18

SP - 344

EP - 351

JO - Tropical Medicine and International Health

JF - Tropical Medicine and International Health

SN - 1360-2276

IS - 3

ER -