Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants.
OBJECTIVES: Infants infected with HIV-1 perinatally despite single-dose nevirapine progress rapidly. Data on treatment outcome in sub-Saharan African infants exposed to single-dose nevirapine are urgently required. This feasibility study addresses efficacy of infant antiretroviral therapy in this se...
| Egile Nagusiak: | , , , , , , , , , |
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| Formatua: | Journal article |
| Hizkuntza: | English |
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2008
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| _version_ | 1826260376018223104 |
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| author | Prendergast, A Mphatswe, W Tudor-Williams, G Rakgotho, M Pillay, V Thobakgale, C McCarthy, N Morris, L Walker, B Goulder, P |
| author_facet | Prendergast, A Mphatswe, W Tudor-Williams, G Rakgotho, M Pillay, V Thobakgale, C McCarthy, N Morris, L Walker, B Goulder, P |
| author_sort | Prendergast, A |
| collection | OXFORD |
| description | OBJECTIVES: Infants infected with HIV-1 perinatally despite single-dose nevirapine progress rapidly. Data on treatment outcome in sub-Saharan African infants exposed to single-dose nevirapine are urgently required. This feasibility study addresses efficacy of infant antiretroviral therapy in this setting. METHODS: HIV-infected infants in Durban, South Africa, received randomized immediate or deferred (when CD4 cell count reached <20%) four-drug antiretroviral therapy (zidovudine/lamivudine/nelfinavir/nevirapine). Genotyping for non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was undertaken pre-antiretroviral therapy. Monthly follow-up to 1-year post-antiretroviral therapy included viral load, CD4 cell count and verbal/measured adherence monitoring. RESULTS: All 63 infants were exposed to single-dose nevirapine. Twenty-one out of 51 (39%) infants with baseline genotyping results had NNRTI resistance (most frequently Y181C; 20%). Forty-three infants were randomized to immediate antiretroviral therapy (ART): three withdrew pre-antiretroviral therapy; 36 out of 40 completed 1-year of ART. Twenty infants received deferred ART: 17 reached CD4 cell counts less than 20% (median d99) and 13 out of 17 started antiretroviral therapy in year 1. Verbal and measured adherence was 99% and 95%, respectively. One-year post-ART, 49 out of 49 (100%) infants had a viral load less than 400 copies/ml; 46 out of 49 (94%) had viral load less than 50 copies/ml. Ten infants (20%) required second-line ART due to virological failure or tuberculosis treatment, therefore 39 out of 49 (80%) achieved viral load less than 400 copies/ml by intention-to-treat. Time to viral load less than 50 copies/ml correlated with maternal CD4 cell count (r = -0.42; P = 0.005) and infant pre-ART viral load (r = 0.64; P < 0.001). NNRTI mutations had no significant effect on virological suppression. Infants starting immediate compared with deferred ART had fewer illness episodes (P = 0.003), but no significant difference in virological suppression. CONCLUSION: Excellent adherence and virological suppression are achievable in infants, despite high-frequency NNRTI mutations and rapid disease progression. Infants remain relatively neglected in roll-out programmes and ART provision must be expanded. |
| first_indexed | 2024-03-06T19:04:39Z |
| format | Journal article |
| id | oxford-uuid:14b90fcd-2a68-4dbc-93fe-28b8ac4b6a4a |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:04:39Z |
| publishDate | 2008 |
| record_format | dspace |
| spelling | oxford-uuid:14b90fcd-2a68-4dbc-93fe-28b8ac4b6a4a2022-03-26T10:21:21ZEarly virological suppression with three-class antiretroviral therapy in HIV-infected African infants.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:14b90fcd-2a68-4dbc-93fe-28b8ac4b6a4aEnglishSymplectic Elements at Oxford2008Prendergast, AMphatswe, WTudor-Williams, GRakgotho, MPillay, VThobakgale, CMcCarthy, NMorris, LWalker, BGoulder, POBJECTIVES: Infants infected with HIV-1 perinatally despite single-dose nevirapine progress rapidly. Data on treatment outcome in sub-Saharan African infants exposed to single-dose nevirapine are urgently required. This feasibility study addresses efficacy of infant antiretroviral therapy in this setting. METHODS: HIV-infected infants in Durban, South Africa, received randomized immediate or deferred (when CD4 cell count reached <20%) four-drug antiretroviral therapy (zidovudine/lamivudine/nelfinavir/nevirapine). Genotyping for non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance was undertaken pre-antiretroviral therapy. Monthly follow-up to 1-year post-antiretroviral therapy included viral load, CD4 cell count and verbal/measured adherence monitoring. RESULTS: All 63 infants were exposed to single-dose nevirapine. Twenty-one out of 51 (39%) infants with baseline genotyping results had NNRTI resistance (most frequently Y181C; 20%). Forty-three infants were randomized to immediate antiretroviral therapy (ART): three withdrew pre-antiretroviral therapy; 36 out of 40 completed 1-year of ART. Twenty infants received deferred ART: 17 reached CD4 cell counts less than 20% (median d99) and 13 out of 17 started antiretroviral therapy in year 1. Verbal and measured adherence was 99% and 95%, respectively. One-year post-ART, 49 out of 49 (100%) infants had a viral load less than 400 copies/ml; 46 out of 49 (94%) had viral load less than 50 copies/ml. Ten infants (20%) required second-line ART due to virological failure or tuberculosis treatment, therefore 39 out of 49 (80%) achieved viral load less than 400 copies/ml by intention-to-treat. Time to viral load less than 50 copies/ml correlated with maternal CD4 cell count (r = -0.42; P = 0.005) and infant pre-ART viral load (r = 0.64; P < 0.001). NNRTI mutations had no significant effect on virological suppression. Infants starting immediate compared with deferred ART had fewer illness episodes (P = 0.003), but no significant difference in virological suppression. CONCLUSION: Excellent adherence and virological suppression are achievable in infants, despite high-frequency NNRTI mutations and rapid disease progression. Infants remain relatively neglected in roll-out programmes and ART provision must be expanded. |
| spellingShingle | Prendergast, A Mphatswe, W Tudor-Williams, G Rakgotho, M Pillay, V Thobakgale, C McCarthy, N Morris, L Walker, B Goulder, P Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title | Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title_full | Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title_fullStr | Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title_full_unstemmed | Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title_short | Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. |
| title_sort | early virological suppression with three class antiretroviral therapy in hiv infected african infants |
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