%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Van Dyke, R.B.
%A Ngo-Giang-Huong, Nicole
%A Shapiro, D.E.
%A Frenkel, L.
%A Britto, P.
%A Roongpisuthipong, A.
%A Beck, I.A.
%A Yuthavisuthi, P.
%A Prommas, S.
%A Puthanakit, T.
%A Achalapong, J.
%A Chotivanich, N.
%A Rasri, W.
%A Cressey, T.
%A Maupin, R.
%A Mirochnick, M.
%A Jourdain, Gonzague
%T A comparison of 3 regimens to prevent nevirapine resistance mutations in hiv-infected pregnant women receiving a single intrapartum dose of nevirapine
%D 2012
%L fdi:010054298
%G ENG
%J Clinical Infectious Diseases
%@ 1058-4838
%K THAILANDE
%M ISI:000298383700022
%N 2
%P 285-293
%R 10.1093/cid/cir798
%U https://www.documentation.ird.fr/hor/fdi:010054298
%> https://www.documentation.ird.fr/intranet/publi/2012/01/010054298.pdf
%V 54
%W Horizon (IRD)
%X Background. Intrapartum single-dose (SD) nevirapine (NVP) reduces perinatal transmission of human immunodeficiency virus (HIV) infection but selects for NVP-resistant virus, which compromises subsequent NVP-based therapy. A 1-week "tail" of lamivudine and zidovudine after SD-NVP decreases the risk of resistance. We hypothesized that increasing the duration or potency of the tail would further reduce this risk to < 10%, using a sensitive assay to measure resistance. Methods. HIV-infected pregnant Thai women with a CD4 cell count > 250 cells/mu L, most receiving zidovudine, were randomized at 28-38 weeks gestation to receive 1 of 3 intrapartum and postpartum regimens: (A) zidovudine plus enteric-coated didanosine plus lopinavir and ritonavir for 7 days, (B) zidovudine plus enteric-coated didanosine for 30 days, or (C) regimen 1 for 30 days. The incidence of NVP resistance mutations at day 10 or week 6 post partum in each arm was compared with that of a historical comparison group who received prenatal zidovudine and SD-NVP. NVP resistance was identified by consensus sequencing and a sensitive oligonucleotide ligation assay (OLA). Results. At entry, the 169 participants had a median CD4 cell count of 456 cells/mu L and an HIV load of 3.49 log(10) copies/mL. The incidence of mutations in each of the 3 P1032 arms was 0% by sequencing and 1.8%, 7.1%, and 5.3% by OLA in arms A, B, and C, respectively, compared with 13.4% by sequencing and 29.4% by OLA in the comparison group (P < .001 for each study arm vs comparison group). Grade 4 anemia developed in 1 woman. Conclusions. A 7-day tail of highly active combination therapy or 1 month of dual therapy after SD-NVP prevents most NVP resistance to minimal toxicity. Clinical Trials Registration. The IMPAACT P1032 Clinical Trial is NCT00109590, and the PHPT-2 Clinical Trial is NCT00398684.
%$ 052