在延伸奈韦拉平预防方案中加入更昔洛韦可降低在宫内感染 HIV 的婴儿出现奈韦拉平耐药的风险。
Addition of extended zidovudine to extended nevirapine prophylaxis reduces nevirapine resistance in infants who were HIV-infected in utero.
机构信息
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
出版信息
AIDS. 2010 Jan 28;24(3):381-6. doi: 10.1097/QAD.0b013e3283352ef1.
BACKGROUND
In the Post-Exposure Prophylaxis of Infants (PEPI)-Malawi trial, most women received single-dose nevirapine (NVP) at delivery, and infants in the extended study arms received single-dose NVP along with 1 week of daily zidovudine (ZDV), followed by either extended daily NVP or extended daily NVP and ZDV up to 14 weeks of age. Although extended NVP prophylaxis reduces the risk of postnatal HIV transmission, it may increase the risk of NVP resistance among infants who are HIV-infected despite prophylaxis.
METHODS
We analyzed 88 infants in the PEPI-Malawi trial who were HIV-infected in utero and who received prophylaxis for a median of 6 weeks prior to HIV diagnosis. HIV genotyping was performed using the ViroSeq HIV Genotyping System.
RESULTS
At 14 weeks of age, the proportion of infants with NVP resistance was lower in the extended NVP and ZDV arm than in the extended NVP arm (28/45, 62.2% vs. 37/43, 86.0%; P = 0.015). None of the infants had ZDV resistance. Addition of extended ZDV to extended NVP was associated with reduced risk of NVP resistance at 14 weeks if prophylaxis was stopped by 6 weeks (54.5 vs. 85.7%, P = 0.007) but not if prophylaxis was continued beyond 6 weeks (83.3 vs. 87.5%, P = 1.00).
CONCLUSION
Addition of extended ZDV to extended NVP prophylaxis significantly reduced the risk of NVP resistance at 14 weeks in infants who were HIV-infected in utero, provided that HIV infection was diagnosed and the prophylaxis was stopped by 6 weeks of age.
背景
在婴儿暴露后预防（PEPI）-马拉维试验中，大多数妇女在分娩时接受单剂量奈韦拉平（NVP），而在扩展研究组中，婴儿在接受单剂量 NVP 加 1 周每日齐多夫定（ZDV）后，接受延长每日 NVP 或延长每日 NVP 和 ZDV 治疗，直至 14 周龄。尽管延长 NVP 预防可降低产后 HIV 传播的风险，但它可能会增加接受预防的感染 HIV 的婴儿中出现 NVP 耐药的风险。
方法
我们分析了在 PEPI-马拉维试验中感染 HIV 的 88 名婴儿，这些婴儿在 HIV 诊断前中位数接受了 6 周的预防治疗。使用 ViroSeq HIV 基因分型系统进行 HIV 基因分型。
结果
在 14 周龄时，与延长 NVP 组相比，延长 NVP 和 ZDV 组的婴儿中 NVP 耐药的比例较低（28/45，62.2% vs. 37/43，86.0%；P = 0.015）。没有婴儿出现 ZDV 耐药。如果在 6 周时停止预防治疗（54.5% vs. 85.7%，P = 0.007），则在 14 周时，延长 ZDV 与延长 NVP 联合预防可降低 NVP 耐药的风险，但如果延长 ZDV 与延长 NVP 联合预防持续时间超过 6 周（83.3% vs. 87.5%，P = 1.00），则不能降低 NVP 耐药的风险。
结论
如果在 6 周龄时诊断出 HIV 感染并停止预防治疗，在感染 HIV 的婴儿中，延长 ZDV 与延长 NVP 联合预防可显著降低 14 周时 NVP 耐药的风险。
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