Survival in women exposed to single-dose nevirapine for prevention of mother-to-child transmission of HIV: a stochastic model.
BACKGROUND
Single-dose nevirapine (sdNVP)-based regimens reduce mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) but result in resistance to NVP and may reduce the ability of highly active antiretroviral therapy (HAART) used for prevention of MTCT (PMTCT). The impact that sdNVP has on survival in the era of increasing access to HAART is unknown.


METHODS
We developed a stochastic simulation model to predict survival and sdNVP-attributable mortality in sub-Saharan African women exposed to different PMTCT regimens.


RESULTS
Our model predicts that mortality attributable to exposure to sdNVP is low--1.1% (interquartile range [IQR], 0.6%-1.5%) and 3.5% (IQR, 3.1%-3.9%) at 5 and 10 years after PMTCT therapy--when all eligible women receive HAART after PMTCT therapy. Predictions were robust to univariate sensitivity analysis. In the worst-case multivariate sensitivity analysis, the increased mortality attributable to sdNVP was 10.4% (IQR, 10.0%-10.8%) at 10 years after PMTCT therapy.


CONCLUSIONS
Concern has been expressed that widespread use of sdNVP for PMTCT in resource-poor settings will compromise the effectiveness of HAART in HIV-infected women. Although our model does not address other important outcomes of PMTCT regimens, such as transmission of resistant virus, it provides strong arguments that sdNVP for PMTCT should not be delayed because of fear of compromising the survival of women after PMTCT therapy.
Westreich
Daniel
D
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Eron
Joseph
J
Behets
Frieda
F
Horst
Charles van der
Cv
Van Rie
Annelies
A
D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D013269:Stochastic Processes; D016019:Survival Analysis
D019380:Anti-HIV Agents; D019829:Nevirapine