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No Loss of Efficacy for HIV-Infected Women Delivering Second Child: Presented at CROI

By Ed Susman

DENVER, CO -- February 9, 2006 -- Researchers said that pregnant women infected with HIV who employ nevirapine in attempts to prevent mother-to-child transmission of the virus can get similar protection if they used the same drug during a second pregnancy.

"We saw no loss of efficacy when women used nevirapine a second time," said Michael Thigpen, MD, infectious disease specialist, Centers for Disease Control and Prevention, Atlanta, Georgia.

The rate of transmission of HIV to infants was 17.6% among 102 Ugandan women who had taken a single dose of the nonnucleoside reverse transcriptase inhibitor nevirapine for the first time, Dr. Thigpen reported here on February 9^th at the 13^th Conference on Retroviruses and Opportunistic Infections (CROI).

However, among 96 women who took nevirapine a second time to prevent transmission during a second pregnancy, the transmission rate was 14.6%, he said. The differences between the 2 groups did not reach statistical significance (P = .64).

In resource-poor settings, a strategy to prevent mother-to-child transmission of HIV at birth is to deliver a single dose of nevirapine to the mother during delivery and then to the infant. However, research has shown that there is a high risk that HIV will develop resistance to nevirapine, which would prevent the drug from being useful either in a second pregnancy or in subsequent attempts to treat the mother with antiretroviral therapy.

"We did not see that resistance in this study," said Dr. Thigpen. In places such as Botswana where highly active antiretroviral therapy [HAART] is being rolled out to all infected citizens, previous use of single-dose nevirapine in the child delivery setting does not appear to be causing problems with resistance, he added.

"If we don't start antiretroviral therapy until at least 6 months after giving the woman single-dose nevirapine, there does not seem to be any resistance problems with delivering HAART therapy," he said.

There were some resistance issues raised if the antiretroviral therapy was initiated within 6 months of nevirapine's use in attempting to prevent vertical transmission to the baby, he noted.

Without treatment at delivery, between 21% and 40% of children born to infected mothers are born infected with HIV.


[Presentation title: Effectiveness of Repeat Single-Dose Nevirapine in Subsequent Pregnancies Among Ugandan Women. Abstract 125]

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