Epidemiology

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CD4+ cell count and risk for antiretroviral drug resistance among women using peripartum nevirapine for perinatal HIV prevention

  1. BJ Dorton1,
  2. J Mulindwa1,2,
  3. MS Li1,3,
  4. NT Chintu1,3,
  5. CJ Chibwesha1,3,
  6. F Mbewe1,
  7. LM Frenkel4,5,
  8. JSA Stringer1,3,
  9. BH Chi1,3

Article first published online: 24 DEC 2010

DOI: 10.1111/j.1471-0528.2010.02835.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 118, Issue 4, pages 495–499, March 2011

Additional Information

How to Cite

Dorton, B., Mulindwa, J., Li, M., Chintu, N., Chibwesha, C., Mbewe, F., Frenkel, L., Stringer, J. and Chi, B. (2011), CD4+ cell count and risk for antiretroviral drug resistance among women using peripartum nevirapine for perinatal HIV prevention. BJOG: An International Journal of Obstetrics & Gynaecology, 118: 495–499. doi: 10.1111/j.1471-0528.2010.02835.x

Author Information

  1. 1

    Centre for Infectious Disease Research in Zambia, Lusaka, Zambia

  2. 2

    University Teaching Hospital, Lusaka, Zambia

  3. 3

    Schools of Medicine and Public Health, University of Alabama, Birmingham, AL, USA

  4. 4

    Seattle Children’s Hospital and Research Institute, Seattle, WA, USA

  5. 5

    University of Washington, Seattle, WA, USA

*B Dorton, Plot 1275, Lubutu Road, PO Box 34681, Lusaka 10101, Zambia. Email bdorts9@gmail.com

Publication History

  1. Issue published online: 10 FEB 2011
  2. Article first published online: 24 DEC 2010
  3. Accepted 14 November 2010. Published Online 24 December 2010.

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Keywords:

  • Antiretroviral therapy;
  • CD4+ cell count;
  • HIV;
  • non-nucleoside reverse transcriptase inhibitor;
  • prevention of mother-to-child transmission;
  • resistance

Please cite this paper as: Dorton B, Mulindwa J, Li M, Chintu N, Chibwesha C, Mbewe F, Frenkel L, Stringer J, Chi B. CD4+ cell count and risk for antiretroviral drug resistance among women using peripartum nevirapine for perinatal HIV prevention. BJOG 2011;118:495–499.

Objective  To determine the association between the antenatal CD4+ cell count and the development of viral drug resistance following the use of peripartum nevirapine (NVP) for perinatal HIV prevention.

Design  Secondary analysis of data from a previously conducted randomised controlled trial.

Setting  Lusaka, Zambia.

Population  HIV-positive pregnant women.

Methods  We analysed the data from a clinical trial of single-dose tenofovir/emtricitabine (TDF/FTC) to reduce viral drug resistance associated with peripartum NVP. The trial population was categorised according to antenatal CD4+ cell count (200–350, 351–500 and >500 cells/μl).

Main outcome measures  The relative risk for acquiring drug resistance, determined by consensus sequencing and oligonucleotide ligation assay (OLA), was estimated using multivariable logistic regression.

Results  Of the 397 study participants, 119 (30%) had a CD4+ count of 200–350 cells/μl, 135 (34%) had a CD4+ count of 351–500 cells/μl and 143 (36%) had a CD4+ count of >500 cells/μl. Among women receiving no intervention, the risk for drug resistance appeared to increase as the CD4+ cell count decreased. Participants with CD4+ cell counts of 200–350 cells/μl randomised to the study arm had the lowest risk, suggesting a higher efficacy of the intervention within this stratum. These results were consistent at 2 and 6 weeks, regardless of how drug resistance was measured.

Conclusions  Women with CD4+ cell counts of 200–350 cells/μl may be at increased risk for viral drug resistance following the use of peripartum NVP. Given the high prevalence of NVP resistance and the clear benefits of treatment, antiretroviral therapy should be initiated among pregnant women with CD4+ cell counts of ≤350 cells/μl.

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