Nevirapine Prophylaxis for the Prevention of Perinatal HIV and the Impact of Resistance Mutations on Subsequent Therapy

Abstract

Evaluation of: Lockman S, Shapiro RL, Smeaton LM et al.: Response to antiretroviral therapy after a single, peripartum dose of nevirapine. N. Engl. J. Med. 356(2), 135–147 (2007). Although single-dose nevirapine given to HIV-infected pregnant women during labor is highly efficacious in preventing intrapartum mother-to-child transmission of HIV, it is associated with the selection of HIV nevirapine resistance mutations, which can compromise the efficacy of subsequent non-nucleosidic reverse transcriptase inhibitor-based regimens. In the context of a perinatal HIV prevention trial where pregnant women were randomized to receive intrapartum nevirapine or placebo, the authors assessed the impact of nevirapine exposure on virologic and immunologic response to nevirapine-based therapy in mothers who initiated therapy in the postpartum period and in their infected infants. Exposure to nevirapine was associated with an increased risk of virologic failure by the 6-month visit after treatment initiation in both women and infants. However, in the subgroup of women who initiated therapy more than 6 months after delivery, this association was not statistically significant. While the increase in CD4+ cell count by the 6-month visit was significantly different according to previous exposure to nevirapine in infants, this was not observed in the women.