Timing of Maternal and Infant Nevirapine and the Risk of Mother-to-child Transmission of HIV

Despite a growing emphasis worldwide on complex and potent antiretroviral drug regimens for the prevention of mother-to-child transmission of HIV-1 (MTCT), two-dose nevirapine/NVP (Viramune) prophylaxis remains an important choice in many settings.

Researchers analyzed data from a multicenter clinical trial to determine whether timing of maternal or infant NVP was associated with MTCT risk between delivery and 6 weeks of age (intrapartum/early postnatal transmission, or I/EP).

HIVNET 024 was a placebo-controlled, double-blinded trial of empiric antibiotics to reduce chorioamnionitis-associated MTCT. Enrolled women were instructed to self-administer NVP at labor onset; infants received a dose within 72 hours of birth.

This analysis included data from all HIVNET 024 enrollees if infant HIV-1 diagnostic assay (RNA PCR) results were available at birth and at 6 weeks and if the birth assay was negative.

Results

·   Data regarding 1490 mother-infant pairs were analyzed.

·   The overall I/EP HIV-1 transmission rate was 8.0% at 6 weeks.

·   Variations in mother or infant dose timing did not influence transmission rates, even when the combined pattern of both was taken into account through multivariate analysis.

In the subset of women ingesting NVP < 2 hours before delivery, early NVP administration to the infant (<4 hours after birth) was not associated with lower MTCT risk when compared with later administration (³ 4 hours).

The authors conclude, “Variations in the timing of maternal and infant NVP doses (within reasonable proximity to delivery) do not appear to affect the risk of MTCT.”

UAB Centre for Infectious Disease Research in Zambia, Lusaka, Zambia, Statistical Center for HIV/AIDS Research & Prevention, Seattle, WA, United States of America, NICHD, NIH, DHHS, Bethesda, MD, United States of America, MUCHS-Harvard Research Collaboration, Dar es Salaam, United Republic of Tanzania, University of North Carolina, Chapel Hill, NC, United States of America, University of Washington, Seattle, WA, United States of America, Family Health International, Durham, NC, United States of America, NIAID, NIH, DHHS, Bethesda, MD, United States of America, University of Alabama, Birmingham, AL, United States of America.

08/03/05

Reference
B H Chi and others. Timing of maternal and infant nevirapine and the risk of mother-to-child transmission of HIV-1: HIVNET 024. Abstract TuPp0405 (poster). 3^rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro, Brazil.

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