10 research outputs found
Effectiveness of Non-nucleoside Reverse-Transcriptase Inhibitor-Based Antiretroviral Therapy in Women Previously Exposed to a Single Intrapartum Dose of Nevirapine: A Multi-country, Prospective Cohort Study
In a comparative cohort study, Jeffrey Stringer and colleagues investigate the risk of ART failure in women who received single-dose nevirapine for PMTCT, and assess the duration of increased risk
Baseline characteristics of participants enrolled in the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
<p>*<i>p</i>-Value<0.05, compared to Zambia by Wilcoxon rank-sum test.</p
Study Schema for the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
<p>Among the 779 women who completed 24 wk follow-up on NNRTI-based ART (excluding the three women who were temporarily off therapy), self-reported adherence over the five visits by week 24 was greater than 95% for 440 (95%) of 461 NVP-unexposed women and 300 (94%) of 318 NVP-exposed women (<i>p</i> = 0.5). Among the 724 women who completed 48 weeks on NNRTI-based ART, self-reported adherence over the two visits at weeks 36 and 48 was greater than 95% for 419 (97%) of 433 NVP-unexposed women and 280 (96%) of 291 NVP-exposed women (<i>p</i> = 0.7). f/u, follow-up; LTFU, lost to follow-up.</p
Time between exposure to single-dose NVP and starting antiretroviral therapy and the probability of treatment failure in the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
<p>Locally weighted regression (LOESS) models of the risk of treatment failure as a function of the time interval between NVP ingestion and starting ART. The left panel defines treatment failure according to the study's primary definition; the right panel defines treatment failure according to a planned secondary definition (see <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#s3" target="_blank">Methods</a>). The horizontal dotted line indicates the failure rate among the women who were not exposed to single-dose NVP. The individual plusses (+) indicated on each panel represent individual patients who were either failing (top) or not failing (bottom).</p
Relationship between exposure interval and treatment failure at 48 weeks in the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
a<p>Adjusted ORs controlling for country, CD4 cell count, viral load, WHO stage, age, hemoglobin, and body mass index (all as categorical variables as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed-1000233-t001" target="_blank">table 1</a>). See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#s3" target="_blank">methods</a> for definition of primary analysis.</p>b<p>Adjusted ORs controlling for country, CD4 cell count, viral load, WHO stage, and age (all as categorical variables as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed-1000233-t001" target="_blank">table 1</a>) – hemoglobin and body-mass index were not retained in the final model.</p>c<p>Adjusted ORs controlling for country, CD4 cell count, viral load, WHO stage, and age (all as categorical variables as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed-1000233-t001" target="_blank">table 1</a>) - hemoglobin and body-mass index were not retained in the final model. A separate multivariate model that included self-reported adherence did not alter the adjusted ORs in any appreciable way. See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#s3" target="_blank">methods</a> for definition of on-treatment analysis.</p><p>Ref, reference group.</p
Baseline characteristics of participants enrolled by prior exposure to single-dose nevirapine in the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
<p>*<i>p</i>-Value<0.05, compared to unexposed by Wilcoxon rank-sum test.</p
Factors associated with treatment failure in the primary analysis in the NNRTI Response Study—Zambia, Kenya, Thailand (2005–2008).
<p>See <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#s3" target="_blank">Methods</a> for definition of primary analysis.</p>a<p>Adjusted ORs controlling for country, CD4 cell count, viral load, WHO stage, age, hemoglobin, and body mass index (all as categorical variables as in <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed-1000233-t001" target="_blank">Table 1</a>. Twenty-one observations are not included, owing to missing baseline results for either viral load or hemoglobin.</p><p>Ref, referent group.</p
Studies of virologic response rates to NNRTI-based treatment among women previously exposed to single-dose NVP.
a<p>Some studies report outcomes at additional time points that are not listed here.</p>b<p>Women who received ZDV or ZDV/3TC typically received the regimen from ∼36 wk gestation.</p>c<p>Numbers of patients includes those from whom a virologic response was available in the report.</p>d<p>Proportions estimated by Kaplan-Meier method for references <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed.1000233-Lockman1" target="_blank">[17]</a> and <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed.1000233-Coovadia1" target="_blank">[28]</a>. All others are raw proportions.</p>e<p>Women who received NVP for PMTCT in this study got SDNVP alone, ZDV + SDNVP, or ZDV/3TC + SDNVP. Response rates listed here are from <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed-1000233-t003" target="_blank">Table 3</a> in reference <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1000233#pmed.1000233-Kuhn1" target="_blank">[27]</a>. <i>p</i>-Value calculated using Fisher's exact test.</p>f<p>All women in Thailand who were exposed to SDNVP also received antenatal ZDV; in Zambia and Kenya antenatal ZDV was not used. <i>p</i>-Values calculated using Fisher's exact test for each exposure interval compared to SDNVP unexposed.</p><p>SDNVP, single dose intrapartum nevirapine.</p
Interval between exposure to single-dose nevirapine and starting NNRTI-based antiretroviral therapy in the NNRTI Response Study—Zambia, Kenya, Thailand (2005 – 2008).
<p>Interval between exposure to single-dose nevirapine and starting NNRTI-based antiretroviral therapy in the NNRTI Response Study—Zambia, Kenya, Thailand (2005 – 2008).</p