Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Delay in use of nevirapine-based AIDS treatment can improve outcomes

12.01.2007
Delaying the use of nevirapine-containing antiretroviral therapy (ART) for at least six months after labor may improve treatment outcomes among HIV-infected women in developing countries who took nevirapine during labor to prevent their babies from becoming infected, suggests a new study in The New England Journal of Medicine. The findings could potentially change treatment approaches for millions of mothers infected with the AIDS virus. The study appears in the January 11, 2007, issue of the journal.

Nevirapine, given once during labor, either alone or in combination with a short course of zidovudine (AZT) or other antiretroviral medications, significantly reduces the chances that a pregnant woman will pass HIV to her child. A single dose of nevirapine during labor is frequently all that is accessible to pregnant women in resource-limited settings where more complicated and expensive, multidrug treatments may not be available.

The use of single-dose nevirapine has successfully reduced mother-to-infant transmission of HIV, but has also created a terrible dilemma for physicians and patients. Research has shown that 20 to 69 percent of women who take a single dose of nevirapine during labor subsequently develop resistance to the drug -- a situation that may undermine the patients" ability to respond later to nevirapine-containing ART when they may need the treatment to save their lives. Nevirapine is the cornerstone of three-drug ART in most regions of the world. Drug resistance develops as well in a range of the minority of infants who become HIV infected, despite the use of single-dose nevirapine.

Now, a team of researchers led by Shahin Lockman, Assistant Professor in the Department of Immunology and Infectious Diseases at Harvard School of Public Health (HSPH) and at Brigham and Women's Hospital, and Max Essex, chair of the HSPH AIDS Initiative, has conducted a study that suggests a potential solution to this problem. The results may help women who already received a single dose of nevirapine during labor and those who have not yet given birth.

Working within a randomized clinical trial established by the Botswana-HSPH AIDS Initiative Partnership for HIV Research and Education, the team conducted a prospective observational study that included 218 postpartum, HIV-infected women who had received a single dose of nevirapine during labor, in addition to a short course of AZT during pregnancy. Sixty women started nevirapine-based ART within six months of giving birth, and the remaining women began the regimen after that time had passed.

Of the 60 women who started nevirapine-based ART within six months of giving birth, 24 had received a single dose of nevirapine during labor, while 36 had received a placebo. (All of the women in the study were given zidovudine from 34 weeks into their pregnancies through delivery; similar to nevirapine, zidovudine reduces HIV transmission from mother to child.) Of the women in this group who received a single dose of nevirapine during labor, 41.7 percent subsequently experienced treatment failure, or "virologic failure," within a half a year of starting ART -- compared to zero percent among the women in this group who had received placebo during delivery. Similar differences were found at follow-up visits one and two years after ART had started.

In contrast, there were no statistically significant differences in failure rates within the women who delayed ART for six months -- regardless of whether they had received a single dose of nevirapine during labor or not. This group (and additional women who have joined the study since) continues to be followed to ensure that no differences emerge as the women receive treatment over a longer period of time, said Dr. Lockman.

She added that these findings may be explained by the fact that the amount of nevirapine-resistant HIV in the body decreases as time passes from the time of exposure to single-dose nevirapine during labor.

Said Dr. Essex, "These results translate into very clear policy for how to treat AIDS in new mothers who received nevirapine to protect their infants. If you can wait six months to administer nevirapine-based ART, do so. If not, treat only with combinations of drugs that do not contain nevirapine or nevirapine-related drugs. Implementing this policy can improve the health of women who need AIDS treatment."

Treatment response was also measured among 30 infants in the study who received nevirapine-based ART. More than three-quarters of the 15 infants who were exposed to single dose nevirapine as newborns did not respond adequately to the triple-drug treatment (compared with 9.1 percent of the 15 infants without prior nevirapine exposure). While these results raise concerns regarding the use of nevirapine-based ART for infants following single-dose nevirapine exposure, said Dr. Lockman, the group of infants studied was small, and additional data among infants is needed.

Summarized Dr. Lockman, "Women who need combination ART for their own health during pregnancy should absolutely receive combination ART whenever possible. However, single-dose nevirapine remains important in preventing mother-to-child transmission of HIV in many locales where it is still the only intervention available. This study provides some important guidance and measured reassurance regarding the timing and effectiveness of nevirapine-based antiretroviral treatment for the many women with AIDS who previously received single-dose nevirapine in labor."

Christina Roache | EurekAlert!
Further information:
http://www.hsph.harvard.edu

More articles from Health and Medicine:

nachricht Rabies viruses reveal wiring in transparent brains
19.01.2017 | Rheinische Friedrich-Wilhelms-Universität Bonn

nachricht On track to heal leukaemia
18.01.2017 | Universitätsspital Bern

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

New Study Will Help Find the Best Locations for Thermal Power Stations in Iceland

19.01.2017 | Earth Sciences

Not of Divided Mind

19.01.2017 | Life Sciences

Molecule flash mob

19.01.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>