Kinetics of Nevirapine and Its Impact on HIV-1 RNA Levels in Maternal Plasma and Breast Milk Over Time After Perinatal Single-Dose Nevirapine
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
JAIDS Journal of Acquired Immune Deficiency Syndromes
Abstract
To determine kinetics after single-dose nevirapine and
the impact on HIV RNA [viral load (VL)] in maternal plasma and
breast milk (BM).
Methods: Cohort of 120 HIV-1–infected pregnant Ugandan
women received perinatal single-dose nevirapine alone and followed
up with their infants through 24 weeks postdelivery. We assessed the
relationship of nevirapine concentration (tandem mass spectroscopy)
and HIV-1 VL (Roche AMPLICOR HIV-1 Kit, version 1.5) in
maternal plasma and BM over time.
Results: At week 1 postpartum, NVP ($10 ng/mL) was detected in
all 53 plasma and 47 of 51 (92.2%) BM samples with median (inter-
quartile ranges) of, respectively, 171 (78–214) ng/mL and 112
(64–158) ng/mL, P = 0.075, which decreased subsequently with
traces persisting through week 4 in plasma. Plasma and BM VL
dropped by week 1 and were highly correlated at delivery
(R = 0.71, P , 0.001) and week 1 (R = 0.69, P , 0.001) but not
thereafter. At week 1, VL correlated inversely with NVP concentra-
tion in plasma (R = 0.39, P = 0.004) and BM (R = 0.48, P = 0.013).
There was a VL rebound in both compartments, which peaked at
week 4 to levels greater than those at week 1 [significantly in plasma
(P , 0.001) but not in BM] and remained stable thereafter. Median
VL was consistently greater (11- to 50-fold) in plasma than BM at all
time points (all P , 0.001).
Conclusions: After single-dose nevirapine, NVP concentration was
comparably high through week 1, accompanied by suppression of
plasma and BM VL. A longer “tail” (.1 week) of potent postnatal
antiretroviral drugs is warranted to minimize the observed VL rebound
and potential for NVP resistance as a result of persistent NVP traces
Description
Keywords
Nevirapine, HIV-1 RNA, Maternal plasma, Breast milk
Citation
Aizire, J., McConnell, M. S., Mudiope, P., Mubiru, M., Matovu, F., Parsons, T. L., ... & Fowler, M. G. (2012). Kinetics of nevirapine and its impact on HIV-1 RNA levels in maternal plasma and breast milk over time after perinatal single-dose nevirapine. JAIDS Journal of Acquired Immune Deficiency Syndromes, 60(5), 483-488.