3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

6-MONTH IMMUNOLOGICAL RESPONSE WITH HAART CONTAINING NEVIRAPINE IN HIV-INFECTED WOMEN POST EXPOSURE TO SINGLE DOSE OF NEVIRAPINE FOR PMTCT. THE MTCT-PLUS INITIATIVE IN ABIDJAN, CôTE D’IVOIRE (2003-2005)

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. MoOa0203

Bedikou G.¹, Viho I.¹, Tonwe-Gold B.¹, Coffie J.P.², Amani-Bosse C.¹, Allou G.¹, Sakarovitch C.²2, Toure S.¹, Ekouevi D.K.¹, Leroy V.², Abrams E.J.³, Dabis F.^2
1Programme MTCT-Plus, Aconda, Abidjan, Côte D'Ivoire, ²Unité INSERM 593, Institut De Santé Publique, Epidémiologie Et Développement (ISPED), Bordeaux, France, ³The MTCT-Plus Initiative, Mailman School Of Public Healths, Columbia University, New-York, United States of America

INTRODUCTION: Single-dose nevirapine (sdNVP) is known to induce viral resistance when used to prevent mother-to-child of HIV-1 transmission (PMTCT). In resource-limited settings NNRTI based HAART, using NVP, is the WHO-recommended first-line regimen for adults. We studied the immunological response in women treated with NVP-based HAART according to their previous exposure to sdNVP (sdNVP+) for PMTCT in Abidjan.

METHODS: MTCT-Plus is a multi-country care and treatment program built upon existing PMTCT services. It provides pregnant and postpartum women, their partners and children with family-centered HIV care including HAART when they meet WHO eligibility criteria (WHO stage 4, stage 2 or 3 with CD4 count <350/mm³ and CD4<200/mm³).

RESULTS: From August 2003 to February 2005, 530 women were enrolled and 209 HIV-infected women including 92 (44%) pregnant women were initiated HAART. Among these women, 115 (55%) had received previously sdNVP for PMTCT including 49 with ZDV and 66 with ZDV+3TC. The delay in median between PMTCT intervention and HAART initiation was 19 months. The median CD4 count was 191/mm³. The first-line regimens initiated by the women were ZDV+3TC+NVP (93%), D4T+3TC+NVP (3%) and other regimens (4%). Median follow-up on HAART was 7.5 months. At 6 months on treatment, the CD4 count increased in median by 205 cells/mm³; IQR [125-313/mm³] in 127 women who had measurements available. No statistical difference in CD4 count was found between the 64 women sdNVP+ and the 63 women sdNVP- (189/mm³ vs 222/mm³, p=0.53). At 12 months, the CD4 count increased in median of 307/mm³ [188-451] in women sdNVP+ (n=15) and 289/mm³ [161-364] (n=27) in women sdNVP- (p=0.37).

CONCLUSIONS: The 6-month immunological response was similar in women previously exposed or not to sdNVP before initiating HAART. Further followup is necessary to fully assess the long-term, impact of sdNVP used for PMTCT on the success of NNRTI containing therapeutic regimens.

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