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15th International AIDS conference: Nevirapine reduces perinatal HIV transmission in women tested and treated during labour

BMJ 2004; 329 doi: (Published 15 July 2004) Cite this as: BMJ 2004;329:132
  1. Susan Mayor
  1. Bangkok

    Treatment with nevirapine reduces perinatal transmission of HIV in women tested and treated during labour, a study done in Malawi has shown (JAMA 2004;292:202-9).

    Antenatal counselling and HIV testing are not universally available in Africa, so many women present in labour with unknown HIV status. The study included all infants born to 894 HIV positive women (from a total of 9469 women screened) who presented in labour to six clinics in Blantyre, Malawi.

    Those included in the study were early presenters (those arriving at least four hours before delivery was predicted) to allow time for obtaining informed consent, counselling, HIV testing, reporting of results, and treatment. Of the 9469 women screened, 8575 were excluded, including 3485 who tested negative and 2699 who refused consent to testing, mainly because they were unable to ask their husband's permission; the rest were excluded because either they refused to take part (105) or their infants met the exclusion criteria (2286).

    The women in the study were treated with nevirapine intrapartum (200 mg single oral dose), and the infants were randomly assigned to one of two regimens—nevirapine alone (2 mg/kg, single oral dose) (n=448) or nevirapine (same dose) plus zidovudine (4 mg/kg twice a day) (n=446) for one week. Combination therapy was tested to see if it reduced the development of resistance to nevirapine.

    Results showed that mother to child transmission occurred in 8.1% of infants given nevirapine alone and in 10.1% of those given nevirapine plus zidovudine. For infants not infected at birth and retested at six to eight weeks, HIV infection was detected in 6.5% of those treated with nevirapine alone and in 6.9% of those given combination therapy. Almost all of the babies (99-100%) were breast fed.

    Taha Taha, associate professor and codirector of the infectious diseases programme at Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, and principal investigator for the HIV Prevention Trials Network in Blantyre, Malawi, said: “Ideally, voluntary HIV testing should be available early during pregnancy, allowing HIV infected women and their infants to receive standard nevirapine prophylaxis. Our study—and other studies in Africa—indicated that women could self administer treatment when labour contractions commence.”

    Presenting the study at the 15th international AIDS conference, he added: “Women who present at the labour ward with unknown HIV status should be tested and offered a standard nevirapine regimen, together with treatment of their infants.”

    The results showed that nevirapine achieved similar reduction in HIV transmission to the combination of nevirapine plus zidovudine. Dr Taha noted, however, that the combination could be of more value if it reduced the appearance of resistance by reducing HIV replication. Testing for resistance in samples collected from the study is currently under way. He added: “Additional research should focus on evaluating extended antiretroviral regimens to prevent transmission of HIV via breast milk.”

    Roche paid for flights and accommodation for Susan Mayor to attend the XV International AIDS conference.

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