title: Long-term clinical and immunologic outcomes of HIV-infected women with and without previous exposure to nevirapine.
abstract: OBJECTIVE
  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/mm(3)  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.
authors.affiliation: Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda. pmudiope@mujhu.org
authors.forename: Peter K
authors.initials: PK
authors.lastname: Mudiope
authors.forename: Soyeon
authors.initials: S
authors.lastname: Kim
authors.forename: Deo
authors.initials: D
authors.lastname: Wabwire
authors.forename: Louis
authors.initials: L
authors.lastname: Nyende
authors.forename: Danstan
authors.initials: D
authors.lastname: Bagenda
authors.forename: Mike
authors.initials: M
authors.lastname: Mubiru
authors.forename: Robinah
authors.initials: R
authors.lastname: Mulira
authors.forename: Sawsan
authors.initials: S
authors.lastname: Elbireer
authors.forename: Zikulah
authors.initials: Z
authors.lastname: Namukwaya
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D019829:Nevirapine / Q000008:administration & dosage* / Q000494:pharmacology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents; D019829:Nevirapine