Antiretroviral Therapy In Women Research Articles

Walking the Tightrope in Prevention of Mother-to-Child Transmission of HIV Infection

A fine balance needs to be struck in our efforts to prevent pediatric HIV infection: the need for optimal regimens to drive down infection rates among infants must not compromise the therapeutic response of antiretroviral therapy in women when they eventually require it for their own health. Previous studies have demonstrated that 15%-69.5% of HIV-infected women will have resistance mutations to nevirapine (NVP) after its use in a singledose intervention to prevent mother-to-child transmission of HIV (MTCT). The occurrence of viral NVP resistance mutations has been found to reduce the response to NVP-containing regimens if initiated within 6 months after exposure to single-dose NVP. The acquisition of NVP resistance can be reduced substantially by using a zidovudine (ZDV) or lamivudine (3TC) tail for 4-7 days after delivery thereby preserving use of singledose NVP treatment in the intrapartum period for prevention of MTCT and in subsequent antiretroviral therapy. (excerpt)

High Sensitivity C-Reactive Protein and Response to Highly Active Antiretroviral Therapy in Women with HIV-1 Infection

High Sensitivity C-Reactive Protein and Response to Highly Active Antiretroviral Therapy in Women with HIV-1 Infection

Maternal hepatotoxicity with nevirapine as part of combination antiretroviral therapy in pregnancy

To describe the maternal tolerability of nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland and to determine risk factors for development of significant hepatotoxicity. A retrospective study was carried out of all women prescribed nevirapine as part of combination antiretroviral therapy in pregnancy at three HIV centres in Dublin, Ireland (October 2000 to February 2003). Toxicities experienced were graded according to the Division of AIDS toxicity guidelines for adults. Statistical analysis was performed to determine whether there were differences between those that did and those that did not experience significant hepatotoxicity. A total of 123 women initiated nevirapine as part of combination antiretroviral therapy in the study period. Eight women developed significant hepatotoxicity, including two women who died from fulminant hepatitis. Women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts (P=0.01). In this cohort, women who experienced more severe hepatotoxicity had higher pretreatment CD4 counts, lending additional weight to the need for caution in using nevirapine as part of combination antiretroviral therapy in women not requiring antiretroviral therapy for their own health.

Prevention of perinatal transmission

<h2>Abstract</h2> During 2003, 660,000 children were infected with HIV in utero, during delivery or post-partum through breast-feeding. HIV transmission can be almost completely prevented by exclusive formula-feeding, pre-labour Caesarean section and antiretroviral therapy. Single-dose nevirapine has been shown to be effective in reducing peripartum transmission, but the rapid development of resistance is an increasing concern in non-breast-feeding populations. Zidovudine monotherapy plus pre-labour Caesarean section is associated with less than 1% transmission. Effective combination therapies that reduce maternal viraemia to below the limit of detection are likely to be similarly or more effective. The role of pre-labour Caesarean section in women with a plasma HIV RNA load of less than 50 copies/ml is uncertain. The toxicities of combination antiretroviral therapy in women and their babies must be carefully balanced against the benefits.

Association of Provider and Patient Characteristics With HIV-Infected Women's Antiretroviral Therapy Regimen

Objective: We explored the effect of patient and provider factors on the type of antiretroviral regimen among women receiving therapy. Patients: Five hundred ninety-five New York State nonpregnant HIV+ women with full Medicaid eligibility and at least 1 month of a prescribed antiretroviral regimen in federal fiscal years (FFY) 1997-1998 and intervals in FFY 1997-1998, who had delivered a liveborn baby within 5 years. Measurements: From pharmacy claims in 4 6-month intervals in FFY 1997-1998, data were extracted on (1) an acceptable ≥2 antiretroviral combination regimen per expert guidelines; and (2) a highly active regimen, including a protease inhibitor or nonnucleoside analog (highly active antiretroviral therapy [HAART]). Results: Of 1514 woman-6-month intervals with filled antiretroviral prescriptions, 82% had an acceptable regimen, and of 1246 woman-6-month intervals on acceptable antiretroviral therapy, half demonstrated the use of HAART. Adjusted odds ratios (AORs) of acceptable antiretroviral therapy were higher (p < .05) for HIV specialty care (AOR = 1.71 for one or two visits; AOR = 2.10 for 3+ visits) or HIV clinical trials site care (AOR = 1.43; 95% confidence interval [CI]: 1.01, 2.04). Among women on acceptable antiretroviral regimens, those aged older than 25 years (AOR = 1.69; CI: 1.13, 2.53) or who were high school graduates (AOR = 1.50; CI: 1.09, 2.06) had higher odds of HAART. Mcthadone-treated women had twofold and nearly threefold higher AORs of acceptable antiretroviral regimens and HAART, respectively, than current drug users. Conclusion: Provider HIV expertise is associated with receipt of an acceptable antiretroviral regimen in women, although receipt of HAART is affected more by age, education, and current drug abuse. Methadone treatment seems to improve access to acceptable antiretroviral regimens as well as to HAART.

Association of provider and patient characteristics with HIV-infected women's antiretroviral therapy regimen.

We explored the effect of patient and provider factors on the type of antiretroviral regimen among women receiving therapy. Five hundred ninety-five New York State nonpregnant HIV+ women with full Medicaid eligibility and at least 1 month of a prescribed antiretroviral regimen in federal fiscal years (FFY) 1997-1998 and intervals in FFY 1997-1998, who had delivered a liveborn baby within 5 years. From pharmacy claims in 4 6-month intervals in FFY 1997-1998, data were extracted on (1) an acceptable > or = 2 antiretroviral combination regimen per expert guidelines; and (2) a highly active regimen, including a protease inhibitor or nonnucleoside analog (highly active antiretroviral therapy [HAART]). Of 1514 woman-6-month intervals with filled antiretroviral prescriptions, 82% had an acceptable regimen, and of 1246 woman-6-month intervals on acceptable antiretroviral therapy, half demonstrated the use of HAART. Adjusted odds ratios (AORs) of acceptable antiretroviral therapy were higher (p < .05) for HIV specialty care (AOR = 1.71 for one or two visits; AOR = 2.10 for 3+ visits) or HIV clinical trials site care (AOR = 1.43; 95% confidence interval [CI]: 1.01, 2.04). Among women on acceptable antiretroviral regimens, those aged older than 25 years (AOR = 1.69; CI: 1.13, 2.53) or who were high school graduates (AOR = 1.50; CI: 1.09, 2.06) had higher odds of HAART. Methadone-treated women had twofold and nearly threefold higher AORs of acceptable antiretroviral regimens and HAART, respectively, than current drug users. Provider HIV expertise is associated with receipt of an acceptable antiretroviral regimen in women, although receipt of HAART is affected more by age, education, and current drug abuse. Methadone treatment seems to improve access to acceptable antiretroviral regimens as well as to HAART.