title: Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: a cohort study.
abstract: BACKGROUND
  Single-dose nevirapine (SDNVP) for the prevention of mother-to-child HIV transmission (PMTCT) results in the selection of resistance mutants among HIV-infected mothers. The effects of these mutations on the efficacy of SDNVP use in a subsequent pregnancy are not well understood.
  
  
  METHODS
  We compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of SDNVP (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a PMTCT clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Logistic regression modeling was used to adjust for possible confounders.
  
  
  RESULTS
  Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage (adjusted odds ratio 0.6, 95% confidence interval [CI] 0.2 to 2.0). Among 43 women who had two consecutive pregnancies during the study, transmission risks were 7% (95% CI 1% to 19%) at both the first (unexposed) and second (exposed) delivery. The results were unchanged, if infant death was included as an outcome.
  
  
  CONCLUSIONS
  These data suggest that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
authors.affiliation: Childrens Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA. jan.wal@web.de
authors.forename: Jan
authors.initials: J
authors.lastname: Walter
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006678:HIV / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D019829:Nevirapine / Q000008:administration & dosage* / Q000627:therapeutic use; D010298:Parity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D019562:Viral Load; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine