CD4, Viral Load Response, and Adherence Among Antiretroviral-Naive Breast-feeding Women Receiving Triple Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV in Kisumu, Kenya
Health benefits and survival of an exclusively breast-fed infant is dependent on the mother's health; thus, the need for antiretroviral (ARV) intervention for prevention of mother-to-child transmission (PMTCT). Achieving maternal health benefits from these regimens requires adherence to the tre...
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| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2012-10, Vol.61 (2), p.249-257 |
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| container_title | Journal of acquired immune deficiency syndromes (1999) |
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| creator | OKONJI, Jully A ZEH, Clement WEIDLE, Paul J WILLIAMSON, John AKOTH, Benta MASABA, Rose O FOWLER, Mary G THOMAS, Timothy K |
| description | Health benefits and survival of an exclusively breast-fed infant is dependent on the mother's health; thus, the need for antiretroviral (ARV) intervention for prevention of mother-to-child transmission (PMTCT). Achieving maternal health benefits from these regimens requires adherence to the treatments and close monitoring. We evaluated virologic, immunologic responses, and adherence among women receiving maternal triple ARV prophylaxis consisting of lamivudine/zidovudine and nevirapine or nelfinavir in the Kisumu Breastfeeding Study.
We analyzed baseline demographic data, trends in CD4 count, and viral load (VL) at enrollment (32-34 weeks gestation), delivery, 14 and 24 weeks postpartum among 434 women who remained in the study at 24 weeks postpartum. Adherence rates were determined using pill counts reinforced by self-report and drug calendar. We dichotomized adherence as ≥95% versus |
| doi_str_mv | 10.1097/QAI.0b013e318262514f |
| format | Article |
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We analyzed baseline demographic data, trends in CD4 count, and viral load (VL) at enrollment (32-34 weeks gestation), delivery, 14 and 24 weeks postpartum among 434 women who remained in the study at 24 weeks postpartum. Adherence rates were determined using pill counts reinforced by self-report and drug calendar. We dichotomized adherence as ≥95% versus <95%.
Among the 434 women, 84% (n = 366) had adherence ≥95%. The proportion of women with undetectable VL (<400 copies/mL) increased from 6% at baseline to 79%, and that of those with CD4 count <250 cells per microliter decreased from 23% (100) at baseline to 5% (22) at 24 weeks postpartum. In discrete-survival model, time to achieving VL suppression was associated with baseline VL <5.0 log copies per milliliter, parity ≥2, and use of nelfinavir- versus nevirapine-based ARV. Association between undetectable VL with duration of therapy (P < 0.0001) and adherence with suppression of VL (P = 0.001) was observed.
High baseline VL and short exposure to ARVs for PMTCT are risk factors for failing to achieve undetectable VL. These findings support the new WHO guidelines for early initiation of ARV prophylaxis for PMTCT for maximal reduction of maternal VL.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0b013e318262514f</identifier><identifier>PMID: 22692094</identifier><identifier>CODEN: JDSRET</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; AIDS/HIV ; Antiretroviral drugs ; Antiretroviral Therapy, Highly Active - methods ; Biological and medical sciences ; Breast Feeding ; Breastfeeding & lactation ; CD4 Lymphocyte Count ; Chemoprevention - methods ; Disease prevention ; Disease transmission ; Female ; Fundamental and applied biological sciences. Psychology ; HIV ; HIV Infections - drug therapy ; HIV Infections - prevention & control ; HIV Infections - transmission ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infectious Disease Transmission, Vertical - prevention & control ; Infectious diseases ; Kenya ; Maternal & child health ; Medical sciences ; Medication Adherence - statistics & numerical data ; Microbiology ; Miscellaneous ; Treatment Outcome ; Viral diseases ; Viral Load ; Virology ; Young Adult</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2012-10, Vol.61 (2), p.249-257</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Oct 1, 2012</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c444t-70700e576c20bb910bea9ed960585c1620a29e964b63e351518094eceaa9d4043</citedby><cites>FETCH-LOGICAL-c444t-70700e576c20bb910bea9ed960585c1620a29e964b63e351518094eceaa9d4043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26403128$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22692094$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OKONJI, Jully A</creatorcontrib><creatorcontrib>ZEH, Clement</creatorcontrib><creatorcontrib>WEIDLE, Paul J</creatorcontrib><creatorcontrib>WILLIAMSON, John</creatorcontrib><creatorcontrib>AKOTH, Benta</creatorcontrib><creatorcontrib>MASABA, Rose O</creatorcontrib><creatorcontrib>FOWLER, Mary G</creatorcontrib><creatorcontrib>THOMAS, Timothy K</creatorcontrib><title>CD4, Viral Load Response, and Adherence Among Antiretroviral-Naive Breast-feeding Women Receiving Triple Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV in Kisumu, Kenya</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>Health benefits and survival of an exclusively breast-fed infant is dependent on the mother's health; thus, the need for antiretroviral (ARV) intervention for prevention of mother-to-child transmission (PMTCT). Achieving maternal health benefits from these regimens requires adherence to the treatments and close monitoring. We evaluated virologic, immunologic responses, and adherence among women receiving maternal triple ARV prophylaxis consisting of lamivudine/zidovudine and nevirapine or nelfinavir in the Kisumu Breastfeeding Study.
We analyzed baseline demographic data, trends in CD4 count, and viral load (VL) at enrollment (32-34 weeks gestation), delivery, 14 and 24 weeks postpartum among 434 women who remained in the study at 24 weeks postpartum. Adherence rates were determined using pill counts reinforced by self-report and drug calendar. We dichotomized adherence as ≥95% versus <95%.
Among the 434 women, 84% (n = 366) had adherence ≥95%. The proportion of women with undetectable VL (<400 copies/mL) increased from 6% at baseline to 79%, and that of those with CD4 count <250 cells per microliter decreased from 23% (100) at baseline to 5% (22) at 24 weeks postpartum. In discrete-survival model, time to achieving VL suppression was associated with baseline VL <5.0 log copies per milliliter, parity ≥2, and use of nelfinavir- versus nevirapine-based ARV. Association between undetectable VL with duration of therapy (P < 0.0001) and adherence with suppression of VL (P = 0.001) was observed.
High baseline VL and short exposure to ARVs for PMTCT are risk factors for failing to achieve undetectable VL. These findings support the new WHO guidelines for early initiation of ARV prophylaxis for PMTCT for maximal reduction of maternal VL.</description><subject>Adolescent</subject><subject>Adult</subject><subject>AIDS/HIV</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral Therapy, Highly Active - methods</subject><subject>Biological and medical sciences</subject><subject>Breast Feeding</subject><subject>Breastfeeding & lactation</subject><subject>CD4 Lymphocyte Count</subject><subject>Chemoprevention - methods</subject><subject>Disease prevention</subject><subject>Disease transmission</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - prevention & control</subject><subject>HIV Infections - transmission</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious Disease Transmission, Vertical - prevention & control</subject><subject>Infectious diseases</subject><subject>Kenya</subject><subject>Maternal & child health</subject><subject>Medical sciences</subject><subject>Medication Adherence - statistics & numerical data</subject><subject>Microbiology</subject><subject>Miscellaneous</subject><subject>Treatment Outcome</subject><subject>Viral diseases</subject><subject>Viral Load</subject><subject>Virology</subject><subject>Young Adult</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkt1u1DAQhSMEoqXwBghZQkhcbIrt2Il9mS4_XXX5VSmXkZNMWFeJHexkxb4iT8WsuoC0V1zZI3_neGZ0kuQpo-eM6uLV53J1TmvKMsiY4jmXTHT3klOmhUgLpcR9vEsuU8EyeZI8ivGWUpYLoR8mJ5znmlMtTpNfy9diQW5sMD1Ze9OSLxBH7yIsiHEtKdsNBHANkHLw7jsp3WQDTMFv94r0g7FbIBcBTJzSDqC1yHzzAzj0acBu9_V1sGMPR1LyKfhxs-vNTxtJ5wPWsAVEvCO-I-_9hB-nk0-XG9u36GFcHGyMh_fL1Q2xjlzZOA_zglyB25nHyYPO9BGeHM6z5OvbN9fLy3T98d1qWa7TRggxpQUtKAVZ5A2nda0ZrcFoaHVOpZINyzk1XIPORZ3jaiWTTOGmcBpjdCuoyM6Sl3e-Y_A_ZohThY010PfGgZ9jxZjK0VZq-h8oyzhnSilEnx-ht34ODgepGMUOMiU1Q0rcUU3wMQboqjHYwYQdQtU-FhXGojqOBcqeHczneoD2r-hPDhB4cQBMbEzf4bobG_9xuaAZ4yr7DeX_wYA</recordid><startdate>20121001</startdate><enddate>20121001</enddate><creator>OKONJI, Jully A</creator><creator>ZEH, Clement</creator><creator>WEIDLE, Paul J</creator><creator>WILLIAMSON, John</creator><creator>AKOTH, Benta</creator><creator>MASABA, Rose O</creator><creator>FOWLER, Mary G</creator><creator>THOMAS, Timothy K</creator><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7U1</scope><scope>7U2</scope><scope>7X8</scope></search><sort><creationdate>20121001</creationdate><title>CD4, Viral Load Response, and Adherence Among Antiretroviral-Naive Breast-feeding Women Receiving Triple Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV in Kisumu, Kenya</title><author>OKONJI, Jully A ; ZEH, Clement ; WEIDLE, Paul J ; WILLIAMSON, John ; AKOTH, Benta ; MASABA, Rose O ; FOWLER, Mary G ; THOMAS, Timothy K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c444t-70700e576c20bb910bea9ed960585c1620a29e964b63e351518094eceaa9d4043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>AIDS/HIV</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral Therapy, Highly Active - methods</topic><topic>Biological and medical sciences</topic><topic>Breast Feeding</topic><topic>Breastfeeding & lactation</topic><topic>CD4 Lymphocyte Count</topic><topic>Chemoprevention - methods</topic><topic>Disease prevention</topic><topic>Disease transmission</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>HIV</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - prevention & control</topic><topic>HIV Infections - transmission</topic><topic>Human immunodeficiency virus</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious Disease Transmission, Vertical - prevention & control</topic><topic>Infectious diseases</topic><topic>Kenya</topic><topic>Maternal & child health</topic><topic>Medical sciences</topic><topic>Medication Adherence - statistics & numerical data</topic><topic>Microbiology</topic><topic>Miscellaneous</topic><topic>Treatment Outcome</topic><topic>Viral diseases</topic><topic>Viral Load</topic><topic>Virology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>OKONJI, Jully A</creatorcontrib><creatorcontrib>ZEH, Clement</creatorcontrib><creatorcontrib>WEIDLE, Paul J</creatorcontrib><creatorcontrib>WILLIAMSON, John</creatorcontrib><creatorcontrib>AKOTH, Benta</creatorcontrib><creatorcontrib>MASABA, Rose O</creatorcontrib><creatorcontrib>FOWLER, Mary G</creatorcontrib><creatorcontrib>THOMAS, Timothy K</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>OKONJI, Jully A</au><au>ZEH, Clement</au><au>WEIDLE, Paul J</au><au>WILLIAMSON, John</au><au>AKOTH, Benta</au><au>MASABA, Rose O</au><au>FOWLER, Mary G</au><au>THOMAS, Timothy K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>CD4, Viral Load Response, and Adherence Among Antiretroviral-Naive Breast-feeding Women Receiving Triple Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV in Kisumu, Kenya</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2012-10-01</date><risdate>2012</risdate><volume>61</volume><issue>2</issue><spage>249</spage><epage>257</epage><pages>249-257</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><coden>JDSRET</coden><abstract>Health benefits and survival of an exclusively breast-fed infant is dependent on the mother's health; thus, the need for antiretroviral (ARV) intervention for prevention of mother-to-child transmission (PMTCT). Achieving maternal health benefits from these regimens requires adherence to the treatments and close monitoring. We evaluated virologic, immunologic responses, and adherence among women receiving maternal triple ARV prophylaxis consisting of lamivudine/zidovudine and nevirapine or nelfinavir in the Kisumu Breastfeeding Study.
We analyzed baseline demographic data, trends in CD4 count, and viral load (VL) at enrollment (32-34 weeks gestation), delivery, 14 and 24 weeks postpartum among 434 women who remained in the study at 24 weeks postpartum. Adherence rates were determined using pill counts reinforced by self-report and drug calendar. We dichotomized adherence as ≥95% versus <95%.
Among the 434 women, 84% (n = 366) had adherence ≥95%. The proportion of women with undetectable VL (<400 copies/mL) increased from 6% at baseline to 79%, and that of those with CD4 count <250 cells per microliter decreased from 23% (100) at baseline to 5% (22) at 24 weeks postpartum. In discrete-survival model, time to achieving VL suppression was associated with baseline VL <5.0 log copies per milliliter, parity ≥2, and use of nelfinavir- versus nevirapine-based ARV. Association between undetectable VL with duration of therapy (P < 0.0001) and adherence with suppression of VL (P = 0.001) was observed.
High baseline VL and short exposure to ARVs for PMTCT are risk factors for failing to achieve undetectable VL. These findings support the new WHO guidelines for early initiation of ARV prophylaxis for PMTCT for maximal reduction of maternal VL.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>22692094</pmid><doi>10.1097/QAI.0b013e318262514f</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult AIDS/HIV Antiretroviral drugs Antiretroviral Therapy, Highly Active - methods Biological and medical sciences Breast Feeding Breastfeeding & lactation CD4 Lymphocyte Count Chemoprevention - methods Disease prevention Disease transmission Female Fundamental and applied biological sciences. Psychology HIV HIV Infections - drug therapy HIV Infections - prevention & control HIV Infections - transmission Human immunodeficiency virus Human viral diseases Humans Infectious Disease Transmission, Vertical - prevention & control Infectious diseases Kenya Maternal & child health Medical sciences Medication Adherence - statistics & numerical data Microbiology Miscellaneous Treatment Outcome Viral diseases Viral Load Virology Young Adult |
| title | CD4, Viral Load Response, and Adherence Among Antiretroviral-Naive Breast-feeding Women Receiving Triple Antiretroviral Prophylaxis for Prevention of Mother-to-Child Transmission of HIV in Kisumu, Kenya |
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