Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants.

Prendergast, A; Mphatswe, W; Tudor-Williams, G; Rakgotho, M; Pillay, V; Thobakgale, C; McCarthy, N; Morris, L; Walker, B; Goulder, P

Journal article

Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants.

Abstract:: 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.

Publication status:: Published

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Cite

Cite this record

APA Style

Prendergast, A., Mphatswe, W., Tudor-Williams, G., Rakgotho, M., Pillay, V., Thobakgale, C., McCarthy, N., Morris, L., Walker, B., & Goulder, P. (2008). Early virological suppression with three-class antiretroviral therapy in HIV-infected African infants. AIDS (London, England), 22(11), 1333–1343.

MLA Style

Prendergast, A., et al. “Early Virological Suppression with Three-Class Antiretroviral Therapy in HIV-Infected African Infants.” AIDS (London, England), vol. 22, no. 11, 2008, pp. 1333–43.

Chicago Style

Prendergast, A, W Mphatswe, G Tudor-Williams, M Rakgotho, V Pillay, C Thobakgale, N McCarthy, L Morris, B Walker, and P Goulder. 2008. “Early Virological Suppression with Three-Class Antiretroviral Therapy in HIV-Infected African Infants.” AIDS (London, England) 22 (11): 1333–43.
Share
Print