AEGiS-ATN: Nevirapine Reduced Mother-to-Child Transmission Better Than AZT -- At 70 Times Less Cost

Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.

Nevirapine Reduced Mother-to-Child Transmission Better Than AZT -- At 70 Times Less Cost

AIDS TREATMENT NEWS Issue #394, September 12, 2003
John S. James

A single dose of nevirapine given to an HIV-positive woman during labor, and a single dose given to her infant soon after birth, reduced HIV transmission 41% better than AZT when the infants were age 18 months, in a study conducted by researchers at Makerere University in Kampala, Uganda, and at the U.S. National Institute of Allergy and Infectious Diseases (NIAID) [1]. About 26% of the children in the AZT group were infected by 18 months, vs. about 16% of children in the nevirapine group. The AZT regimen consisted of one or more doses to the women during labor, and twice-daily doses to the infants during their first week. The simpler nevirapine treatment cost about 70 times less than the AZT treatment.

Nevirapine did not seem to have any long-term antiviral effect. Rather, it gave better early protection when the infants were most vulnerable to infection. After the treatment, infants in both groups continued to get infected at about the same rate due to breastfeeding, which most of the women had stopped by 18 months (the average time breastfeeding was nine months).

An accompanying editorial suggested that two to three days of AZT plus 3TC could be added to the mother's treatment to prevent development of viral resistance to nevirapine, which can happen when even a single dose of nevirapine is used alone. Or, much better, the mothers could be started on combination antiretroviral treatment [2].

About 800,000 children are infected with HIV each year through mother-to-child transmission, and hundreds of thousands of these cases could be prevented. Cost of the nevirapine is not the problem. The main obstacle has been funding and implementing the programs to use it (which usually require testing, counseling, dealing with stigma such as violence against women who test positive, staff training, prenatal care, and associated infrastructure). Only about 1% of Africans now have access to services for prevention of mother-to-child transmission of HIV, according to a World Health Organization report issued September 1, 2003.

References

1. Jackson JB, Musoke P, Fleming T, and others. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: 18-month follow-up of the HIVNET 012 randomized trial. THE LANCET. September 13, 2003; issue 362, number 9387, pages 859-67. [Note: This article and the accompanying editorial below are available free to non-subscribers at http://www.thelancet.com -- free registration is required.]

2. Beckerman KP. Long-term findings of HIVNET 012: The next steps. THE LANCET. September 13, 2003; pages 842-843.

030912
ATN39402

Copyright © 2003 - AIDS Treatment News. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used. Subscription lists are kept confidential. AIDS Treatment News, Subscription and Editorial Office: 1233 Locust St., 5th floor Philadelphia, PA 19107 800/TREAT-1-2 toll-free email: aidsnews@critpath.org http://www.aidsnews.org

Subscription Information: Call 800/TREAT-1-2: Businesses, Institutions, Professionals: $270/year. Includes early delivery of an extra copy by email. Nonprofit organizations: $135/year. Includes early delivery of an extra copy by email. Individuals: $120/year, or $70 for six months. Special discount for persons with financial difficulties: $54/year, or $30 for six months. If you cannot afford a subscription, please write or call. Outside North, Central, or South America, add air mail postage: $20/year, $10 for six months. Back issues available. Fax subscriptions, bulk rates, and multiple subscriptions are available; contact our office for details. Please send U.S. funds: personal check or bank draft, international postal money order, or travelers checks. VISA, Mastercard, and purchase orders also accepted. ISSN # 1052-4207

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .