P22.03
Background: The major disadvantage of single-dose nevirapine is the development of nevirapine resistance in mothers and infants. Co-interventions, such as short-course antiretroviral regimens in combination with single-dose nevirapine and extension of interventions, have been evaluated in this study.
Methods: Systematic search of electronic databases (MEDLINE, EMBASE and Cochrane) was performed. Studies included HIV-infected, pregnant women, who were administered single-dose nevirapine for pMTCT and who were receiving an intervention to reduce nevirapine resistance. Primary outcome was the proportion of nevirapine resistance detected in plasma samples collected ≤3 months postpartum. The reducing effect of drug interventions on nevirapine resistance was assessed in meta-analyses using random effects models and the GRADE approach for quality of evidence.
Results: The estimated pooled proportion of nevirapine resistance using single-dose nevirapine at labor was 31% (95%CI 7.6-54); this was reduced to 21% (95%CI 8.6-33) with addition of antepartum zidovudine. A combination of antepartum zidovudine, single-dose nevirapine and a short (<8 days) postpartum regimen resulted in a major reduction in nevirapine resistance to 0.011% (95%CI -0.11-0.13). The summary effect of 20–30 days of postpartum drug regimens combined with antepartum zidovudine and single-dose nevirapine was associated with a slightly lower incidence of nevirapine resistance, namely 0.003% (95%CI -0.054-0.060).
Conclusions: Antepartum zidovudine plus antiretroviral drugs postpartum have shown to nearly eliminate nevirapine resistance. Although 20–30 days post partum regimens might be slightly more effective compared to a short (<8 days) postpartum regimen, longer term antiretroviral therapy is more complex and more challenging to implement in daily practice. The WHO guideline option A should be followed to achieve a feasible minimum risk of nevirapine resistance in regions where single-dose nevirapine is still being used.
