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HIV/AIDS Vertical Transmission and short-course Nevirapine therapy
Michael Greer. AIDSWEEKLY Plus 2 September 2002. Reposted courtesy of GENDER-AIDS 2002 (Email: [email protected])
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Short-course Nevirapine therapy does not help prevent vertical HIV transmission from women with access to standard treatment regimens, researchers argue.
"A two-dose intrapartum/newborn Nevirapine regimen reduced perinatal human immunodeficiency virus (HIV) transmission in Ugandan women not receiving antenatal anti-retroviral therapy (ART)," explained Alejandro Dorenbaum and colleagues at the University of California in San Francisco and other institutions in the United States, France and the United Kingdom.
ART provides its own defence against mother-to-child HIV transmission, which was not improved by additional Nevirapine treatment, Dorenbaum and co-authors said.
They assessed the benefits of supplemental Nevirapine therapy in 1270 expectant HIV-positive mothers, recruited while undergoing ART at clinics in the United States, Europe, Brazil and the Bahamas. Participating mothers-to-be were given a 200mg Nevirapine tablet or a placebo during labour, with their newborn children receiving a 2mg/kg oral dose two or three days after birth, according to the report.
At roughly 1.5%, perinatal infection rates were virtually identical for Nevirapine- and placebo-treated women, study data showed. The only factors with a significant impact on transmission risk were a low CD4 cell count and an elevated viral load at delivery. Women in both treatment arms were offered the option of Caesarean delivery, with 34% accepting the offer, the researchers noted.
The unexpectedly low vertical transmission rates seen in this study ran counter to its design and forced a premature conclusion (Two-dose intrapartum/newborn Nevirapine and standard anti-retroviral therapy to reduce perinatal HIV transmission. JAMA 2002 Jul 10;288(2):189-98).
"Risk of perinatal HIV transmission was low, and no benefit from additional intrapartum/newborn Nevirapine was demonstrated when women received prenatal care and antenatal ART and elective Caesarean section was made available," Dorenbaum and colleagues concluded.
The corresponding author for this report is: Coleen K. Cunningham
Department of Pediatrics State
University of New York Upstate Medical University 750 E. Adams St
Syracuse, NY 13210,USA
E-mail: [email protected]
Key points reported in this study include:
Short-course Nevirapine therapy doesn't help prevent vertical HIV transmission from women with access to standard treatment regimens;
Previous research showed that a single dose of Nevirapine each for mother and child helps prevent perinatal infection from otherwise untreated women;
However, vertical transmission rates in women undergoing anti-retroviral therapy were unaffected by intrapartum Nevirapine treatment.
Source: AEGiS www.aegis.org/pubs/aidswkly/2002/AW020902.html
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