Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Reuters NewMedia - Wednesday July 14, 1999
Maggie Fox, Health and Science Correspondent

When the mother gets one dose of the drug during labor and her baby gets one dose within three days of birth, the baby's risk of HIV infection is cut by 47 percent, the researchers reported.

"This extraordinary finding is the most recent in our efforts to bring an end to AIDS, not only in the United States but in countries around the world," Health and Human Services (HHS) Secretary Donna Shalala said in a statement. Pregnant mothers now get either a "long" or "short" course of drugs before and during birth and the babies get the drugs afterward for several weeks to prevent transmission.

In the long course, available mostly only in developed countries, women get the original HIV drug, Glaxo-Wellcome's (quote from Yahoo! UK & Ireland: GLXO.L) AZT, starting during the sixth month of pregnancy.

They get an intravenous infusion of AZT while they are in labor, and the babies get the drug for six weeks after delivery.

This course has been shown to reduce transmission by 70 percent, from 25 percent without drugs to 8 percent with AZT.

The short course starts in the last two weeks of pregnancy. Women get AZT orally twice during labor and the baby gets no drug. This reduces mother-to-child transmission around the time of birth by 51 percent.

In one Thailand trial, 19 percent of babies got HIV from their mothers when no drug was given, versus 9.2 percent when the short course of AZT was given. Some clinics also give mothers and children a combination of AZT and Glaxo's 3TC, which seems to cut transmission rates even more.

But in the nevirapine trial, conducted in Uganda, 13 percent of babies who got nevirapine developed HIV infection, compared to 25 percent who got AZT. Mother-to-child transmission rates differ in different countries.

Dr. Thomas Fleming and colleagues at the Fred Hutchison Cancer Research Center in Seattle studied 600 mothers and their babies, half who got nevirapine and half who got AZT.

"In this study, the short-course nevirapine regimen resulted in a 47 percent reduction in mother-to-child HIV transmission compared with a short course of AZT," Dr. Brooks Jackson, who led the study, said in a statement.

The National Institutes of Health estimates the nevirapine two-dose regime is 200 times less expensive than the AZT long course.

"This study represents the most promising advance to date toward the goal of finding strategies that can be used worldwide to prevent the spread of HIV from infected mothers to their infants," said Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, which helped sponsor the study.

Up to 30 percent of pregnant women in parts of sub-Saharan Africa are infected with HIV, and between 25 and 35 percent of their babies will become infected during birth.

The United Nation's UNAIDS program estimated 1,800 babies are born with HIV every day in developing countries.

"This research provides real hope that we may be able to protect many of Africa's next generation from the ravages of AIDS," Ugandan health minister Crispus Kiyonga said.

Nevirapine is one of a relatively new class of HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). Made by Roxane Laboratories, a Boehringer Ingelheim GmbH company, it it sold under the name Viramune.

It is already approved by the U.S. Food and Drug Administration for children. The babies will be followed until they are 18 months old. They still have a risk of getting HIV from their mothers if they are breast-fed.
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