Use
of
Infant-only
Single-dose
Nevirapine
plus
Zidovudine
Reduces
the
Development
of
Nevirapine
Resistance
in
Infants
The
use
of
single-dose
nevirapine
(SD-NVP)-containing
regimens
by
pregnant
women
and/or
their
newborns
is
able
to
prevent
mother-to-child
transmission
of
HIV.
However,
such
regimens
may
lead
to
the
development
of
NVP
resistance
in
some
HIV
positive
women
and
infants
who
acquire
HIV
infection
despite
receiving
HIV
preventive
therapy. This
development
can
potentially
reduce
the
effectiveness
of
SD-NVP
in
subsequent
pregnancies
and/or
in
the
future
treatment
of
HIV
in
women
and
infants. It
has
been
clearly
established
that
the
development
of
NVP
resistance
in
mothers
is
prevented
by
avoiding
maternal
NVP
administration.
In
the
current
study,
published
in
the
February
15,
2006
issue
of
The
Journal
of
Infectious
Diseases,
researchers
at
3 US
medical
centers
evaluated
the
development
of
NVP
resistance
in
infants
who
received
either
SD-NVP
alone
or
a
regimen
of
SD-NVP
plus
zidovudine
(ZDV)
and
whose
mothers
either
had
or
had
not
received
intrapartum
SD-NVP. All
infants
received
SD-NVP,
and
some
randomly
received
zidovudine
(ZDV)
as
well.
Mothers
did
or
did
not
receive
SD-NVP
on
the
basis
of
when
they
arrived
at
the
hospital
for
delivery.
Results
- In
infants
6–8
weeks
of
age,
NVP
resistance
was
less
frequent
when
infants
had
received
SD-NVP
plus
ZDV
and
mothers
had
not
received
SD-NVP
than
when
infants
had
received
SD-NVP
alone
and
mothers
had
received
SD-NVP
(4/15
[27%]
vs.
20/23
[87%];
P
<
.001).
- The
risk
of
MTCT
of
HIV-1
was
comparable
with
these
regimens.
- Infant-only
prophylaxis
also
eliminates
the
development
of
NVP
resistance
in
mothers.
In
conclusion,
the
authors
write,
“Among
the
4 regimens
that
we
studied,
not
providing
intrapartum
SD-NVP
to
mothers
and
providing
SD-NVP
plus
ZDV
to
infants
was
optimal
in
several
respects:
(1)
the
development
of
NVP
resistance
in
mothers
was
eliminated;
and
(2)
the
development
of
NVP
resistance
in
infants
was
substantially
less
frequent,
compared
with
that
observed
for
all
other
regimens.” In
addition
the
authors
emphasize
that
the
risk
of
MTCT
of
HIV
was
“comparable
with
these
regimens.”
In
the
two
randomized
clinical
trials
(the
NVP
plus
ZDV
[NVAZ]
studies,
the
infant-only
regimens
solely
targeted
infants
of
women
who
presented
late
for
delivery.
“These
preliminary
results
are
encouraging
but
need
to
be
confirmed
in
larger
studies,”
conclude
the
study
authors. Johns
Hopkins
University,
Baltimore,
Maryland;
Rutgers
University,
Piscataway,
New
Jersey;
University
of
North
Carolina,
Chapel
Hill. Articles
on
Mother-to-child
Transmission
(MTCT)
of
HIV 01/27/06 Reference
S H Eshleman
and
others.
Development
of
Nevirapine
Resistance
in
Infants
Is
Reduced
by
Use
of
Infant-Only
Single-Dose
Nevirapine
plus
Zidovudine
Postexposure
Prophylaxis
for
the
Prevention
of
Mother-to-Child
Transmission
of
HIV-1.
The
Journal
of
Infectious
Diseases 193(4):
479-481.
February
15,
2006.
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to
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