Drug prevents mother-to-child HIV infection
A study of 1,300 women who tested HIV-positive in labor or late pregnancy and who had not previously received and were not currently receiving other antiretroviral therapy for HIV found that a short dose of nevirapine was comparably effective to a longer dose of zidovudine plus lamivudine in preventing mother-to-child transmission of HIV.
Mother-infant pairs in the large multicenter study, conducted in South Africa where 60,000 infants are infected with HIV each year, were randomized to receive the nevirapine regimen or the zidovudine plus lamivudine regimen. Mothers in the nevirapine group received one dose of 200 mg nevirapine in labor followed by a second 200 mg dose 24 to 48 hours after delivery and a single 6 mg dose to their infants 24 to 48 hours after birth. Mothers in the zidovudine plus lamivudine group received zidovudine 600 mg, then 300 mg every three hours during labor and 300 mg twice daily for the next seven days, plus lamivudine 150 mg twice daily during labor and for the next seven days. Infants in the zidovudine plus lamivudine group received zidovudine 12 mg plus lamivudine 6 mg twice daily for seven days after birth.
Findings include:
• Overall rates of mother-to-child transmission of HIV were 14% in the nevirapine group, compared with 10.8% in the zidovudine plus lamivudine group.
• The rate of mother-to-child transmission was 6.3% for the nevirapine group, compared with 4.3% for the zidovudine plus lamivudine group.
• There were no treatment-related serious adverse events through six weeks in either group.
The most common side effects associated with nevirapine are rash, fever, nausea, and headache.
Nevirapine is manufactured under the brand name Viramune by Boehringer Ingelheim Pharmaceuticals in Ingelheim, Germany. Researchers say they selected the drug for this study because of its ability to be stored at room temperature, an important consideration in developing countries. For details, visit the company’s Web site at www. boehringer-ingelheim.com.
(Next month, Case Management Advisor will provide information on the newest HIV treatment theories and case management strategies for improving patient adherence to antiretroviral therapies.)
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