Nevirapine reduced mother-to-child transmission better than AZT--at 70 times less cost.

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--registration is required.]

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