Important note: Information in this article was accurate in November 2003. The state of the art may have changed since the publication date.
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HIV Treatment Bulletin - November 2003
Polly Clayden, HIV i-Base
A report published in the 13 September issue of The Lancet indicates that reduction of mother to child transmission achieved with single dose nevirapine at six-eight weeks (as demonstrated in earlier findings in the HIVNET 012 study) was sustained at 18 months follow up with an absolute reduction of 10.1% (95% CI 3.5-16.6) in breastfed babies1.
Children in the nevirapine arm also had significantly lower risk of HIV transmission - 15.7% versus 25.8% in the zidovudine arm (mothers and babies receiving short course zidovudine prophylaxis) – and a greater probability of HIV free survival, 80% versus 70%.
In a commentary in the same issue Dr Karen Beckerman2 highlights concerns about the impact of debility of the caregiver on infant and child mortality. She also cautions against the probability of emergence of resistance for the mothers utilising this strategy that could prejudice future treatment options stressing that: “…we must ALL abandon the notion that universally acknowledged principles of antiretroviral therapy do not apply to pregnant women,” and she suggests: “Why not modify the HIVNET 012 protocol to forestall the emergence of resistance?”
In her conclusion, she proposes: “Generic antiretrovirals, prepared in convenient single pill triple combinations for once and twice daily dosing are now available for less than US$1 a day…. Suboptimum single-agent and double agent prophylaxis protocols no longer have a justifiable place in the front lines of the global struggle against HIV/AIDS. It is up to all of us to focus on development of equitable distribution and effective use of these agents now. Once they are widely available, it may be too late.”
References
1. Jackson JB, Musoke P, Fleming T et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child-transmission of HIV1 in Kampala, Uganda: 18 month follow up of the HIVNET 012 randomised trial. Lancet. 2003 Sep 13;362(9387):859-68
2. Beckerman KP 
. Long term findings of HIVNET 012: the next steps. Lancet. 2003 Sep 13;362(9387):842-3
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