UK doctors urge caution over maternal nevirapine use in developed world

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Use of a single dose of nevirapine monotherapy may be enough to narrow future

treatment options for women with HIV, a number of UK HIV specialists warned

today, as US researchers announced that a single dose of nevirapine for mother

Glossary

monotherapy

Taking a drug on its own, rather than in combination with other drugs.

caesarean section

Method of birth where the child is delivered through a cut made in the womb.

treatment-naive

A person who has never taken treatment for a condition.

protease inhibitor (PI)

Family of antiretrovirals which target the protease enzyme. Includes amprenavir, indinavir, lopinavir, ritonavir, saquinavir, nelfinavir, and atazanavir.

naive

In HIV, an individual who is ‘treatment naive’ has never taken anti-HIV treatment before.

and child had cut HIV transmission by 47% when compared with a four week course

of AZT before delivery.

Dr Mervin Tyrer of the Royal Free Hospital warned that in his clinical

experience, the K103N mutation associated with nevirapine resistance could

emerge after a single exposure to the drug. He cited a case seen recently in

which a treatment-naïve woman who opted for the HIVNET 012 (single dose) regimen

was subsequently found to have the K103N mutation.

"Given that recent data suggest equivalence between NNRTI-containing regimens

and PI-containing regimens for people starting treatment, there is a danger that

women's future options could be compromised if they opt for what appears to be a

convenient regimen."

Dr Graham Taylor of St Mary's Hospital, London said that nevirapine

monotherapy would not replace the existing standard of treatment recommended in

the British HIV Association guidelines for antiretroviral therapy in pregnancy.

Where maternal therapy is indicated, he said, HAART remains the best option. In

women with low viral load and high CD4 counts, AZT monotherapy from week 14 of

pregnancy and a caesarean section is proven to reduce transmission rates below

2%. In comparison, the HIVNET 012 study demonstrated a transmission rate of 13%

in the nevirapine monotherapy arm.

A complete overview of current treatment options during pregnancy can be

found on this site at:

href="http://www.aidsmap.com/heading3.asp?heading2=Options+during+pregnancy&newBrowse=true">http://www.aidsmap.com/heading3.asp?heading2=Options+during+pregnancy&newBrowse=true