Important note: Information in this article was accurate in September 2002. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; September 2, 2002
Michael Greer, Senior Medical Writer
"A 2-dose intrapartum/newborn nevirapine regimen reduced perinatal human immunodeficiency virus (HIV) transmission in Ugandan women not receiving antenatal antiretroviral 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 defense against mother-child HIV transmission, which was not improved by additional nevirapine treatment, Dorenbaum and coauthors said.
They assessed the benefits of supplemental nevirapine therapy in 1270 expectant HIV+ mothers, recruited while undergoing ART at clinics in the United States, Europe, Brazil, and the Bahamas. Participating mothers-to-be were given a 200 mg nevirapine tablet or a placebo during labor, with their newborn children receiving a 2 mg/kg oral dose 2 or 3 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 cesarean 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 antiretroviral 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 cesarean 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: cunningc@upstate.edu.
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
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