Long‐term clinical and immunologic outcomes of HIV‐infected women with and without previous exposure to nevirapine

Abstract

Abstractobjectives To determine and compare the clinical and immunologic outcomes for HIV-infected women initiated on antiretroviral therapy (ART), with and without previous exposure to single-dose nevirapine in the MTCT-Plus programme -Kampala, Uganda, from 2003 to 2011.methods Retrospective comparison of prospectively collected programmatic data of clinical and immunologic treatment outcomes among HIV-infected Ugandan women, with and without prior exposure to sdNVP, who received NNRTI-based ART for a median follow-up of 6 years.results Of the 408 women in the programme, 289 (70.8%) were started on ART, of whom 205 (70.9%) had prior exposure to sdNVP. Clinical, immunologic and combined (clinical and or immunologic) treatment failure occurred in 29 (10.0%), 132 (45.7%) and 142 (49.1%) women, respectively. There was no significant difference in the distribution of time to immunologic failure for women by exposure to sdNVP (log-rank P = 0.98). In Cox proportional hazard modelling, exposure to sdNVP was not associated with immunologic failure [adjusted hazard ratio (HR) = 0.89, 95% confidence interval (CI): 0.61-1.30]. CD4 count >100 cells/mm 3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95% CI: 0.22-0.48).conclusions HIV-infected Ugandan women initiated on an NVP-based ART regimen had similar immunologic treatment outcomes irrespective of previous NVP exposure. CD4 cell count prior to initiating HAART was a key prognostic factor for successful long-term immunologic treatment outcomes. In poor settings, regular follow-up of patients on HAART with adequate counselling to promote adherence and safe disclosure may promote low clinical failure rates.

Systematic review of statistically-derived models of immunological response in HIV-infected adults on antiretroviral therapy in Sub-Saharan Africa

“…More similar methods were employed in Survival and Asymptote models to estimate effect sizes and their residuals. In survival models, six out of seven models estimated effect sizes using CPHs [ 17 , 22 , 38 – 40 , 42 ] and Teshome et al 2014 used a stratified-CPH [ 41 ] ( Table 3 ). Four variants of asymptote models, were found: 1.…”

“…In the CPH models studied, authors did not adjust for time-updated variables [ 38 – 40 , 42 ]. It was assumed that patients remained on their initiation regimen throughout the period of follow-up.…”

“…Such causal diagrams, which are based on clinical or biological assumptions, are useful for deciding on the minimal set of covariates to adjust for. Some studies [ 17 , 40 , 42 , 43 , 46 ] did not adjust for covariates, such as age and baseline CD4 count, even if appropriate data had been collected. Prior reviews by Pinzone et al 2012 [ 2 ] and Corbeau et al 2011 [ 61 ] have shown that both baseline age and baseline CD4 count are associated with immunological response to ART.…”