Early clinical and immune response to NNRTI-based antiretroviral therapy among women with prior exposure to single-dose nevirapine.

TLDR: Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes, however, evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes.

Abstract: The objective was to determine whether prior exposure to single-dose nevirapine (NVP) for prevention of mother-to-child HIV transmission (PMTCT) is associated with attenuated CD4 cell response death or clinical treatment failure in women starting antiretroviral therapy (ART) containing non-nucleoside reverse transcriptase inhibitors (NNRTI). Open cohort evaluation of outcomes for women in program sites across Zambia. HIV treatment was provided according to Zambian/World Health Organization guidelines. Peripartum NVP exposure status was known for 6740 women initiating NNRTI-containing ART of whom 751 (11%) reported prior use of NVP for PMTCT. There was no significant difference in mean CD4 cell change between those exposed or unexposed to NVP at 6 (+202 versus +182 cells/ml; P=0.20) or 12 (+201 versus +211 cells/ml; P=0.60) months. Multivariable analyses showed no significant differences in mortality [adjusted hazard ratio (HR) 1.2; 95% confidence interval (CI) 0.8-1.8] or clinical treatment failure (adjusted HR 1.1; 95% CI 0.8-1.5). Comparison of recent NVP exposure with remote exposure suggested a less favorable CD4 cell response at 6 (+150 versus +219 cells/ml; P=0.06) and 12 (+149 versus +215 cells/ml; P=0.39) months. Women with recent NVP exposure also had a trend towards elevated risk for clinical treatment failure (adjusted HR 1.6; 95% CI 0.9-2.7). Exposure to maternal single-dose NVP was not associated with substantially different short-term treatment outcomes. However evidence was suggestive that exposure within 6 months of ART initiation may be a risk factor for poor treatment outcomes highlighting the importance of ART screening and initiation early in pregnancy. (authors)