Addition of 7 days of zidovudine plus lamivudine to peripartum single-dose nevirapine effectively reduces nevirapine resistance postpartum in HIV-infected mothers in Malawi.
BACKGROUND
We assessed whether 7 days of zidovudine + lamivudine postpartum with single-dose nevirapine at labor decreases nevirapine resistance in HIV-infected women in Malawi.


METHODS
HIV-infected pregnant women receiving intrapartum single-dose nevirapine and 7 days of zidovudine + lamivudine (n = 132) and women receiving intrapartum single-dose nevirapine alone (n = 66) were followed from an antenatal visit through 6 weeks postpartum. Plasma specimens at 2 and 6 weeks postpartum were tested for genotypic resistance to nevirapine by population sequencing and sensitive real-time polymerase chain reaction. Poisson regression was used to determine predictors of postpartum nevirapine resistance.


RESULTS
Median HIV RNA was similar at entry (4.27 log vs. 4.35 log, P = 0.87), differed at 2 weeks postpartum (2.67 log vs. 3.58 log, P < 0.0001) but not at 6 weeks postpartum (4.49 log vs. 4.40 log, P = 0.79), between single-dose nevirapine/zidovudine + lamivudine and single-dose nevirapine groups, respectively. Nevirapine resistance, measured by population sequencing and sensitive real-time polymerase chain reaction, was significantly less common in those receiving single-dose nevirapine/zidovudine + lamivudine compared with single-dose nevirapine, respectively, at 2 weeks [10% (4 of 40) vs. 74% (31 of 42), P < 0.0001] and 6 weeks postpartum [10% (11 of 115) vs. 64% (41 of 64), P < 0.0001; adjusted relative risk = 0.18, 95% confidence interval (0.10 to 0.34)].


CONCLUSIONS
The significant decrease in nevirapine resistance conferred by 1 week of zidovudine + lamivudine should help policymakers optimize peripartum HIV prophylaxis recommendations.
Farr
Sherry L
SL
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30345, USA. sfarr@cdc.gov
Nelson
Julie A E
JA
Ng'ombe
Thokozani J
TJ
Kourtis
Athena P
AP
Chasela
Charles
C
Johnson
Jeffrey A
JA
Kashuba
Angela D M
AD
Tegha
Gerald L
GL
Wiener
Jeffrey
J
Eron
Joseph J
JJ
Banda
Harriet N
HN
Mpaso
Mwanangwa
M
Lipscomb
Jonathan
J
Matiki
Chrissie
C
Fiscus
Susan A
SA
Jamieson
Denise J
DJ
van der Horst
Charles
C
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008295:Malawi; D019829:Nevirapine / Q000008:administration & dosage*; D010949:Plasma / Q000821:virology; D016133:Polymerase Chain Reaction; D049590:Postpartum Period; D011247:Pregnancy; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D055815:Young Adult; D015215:Zidovudine / Q000008:administration & dosage*
D019380:Anti-HIV Agents; D012367:RNA, Viral; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine