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

AbstractObjectivesTo 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.MethodsRetrospective 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.ResultsOf 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/mm3 at initiation was associated with reduced incidence of immunologic failure in adjusted analyses (HR = 0.32, 95% CI: 0.22–0.48).ConclusionsHIV‐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.