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Extended nevirapine reduced HIV-1 risk for nursing newborns
Coovadia HM. Lancet. 2011;doi:10.1016/S0140-6736(11)61653-X.
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A 6-month regimen of nevirapine prophylaxis was safe and reduced mother-to-child transmission of HIV-1 by more than 50% among nursing infants of HIV-infected mothers, according to study results.
Researchers observed a 54% reduction in mother-to-child transmission of HIV with 6 month- nevirapine vs. the shorter course of 6 weeks. Of the infants who received extended nevirapine, 1.1% (95% CI, 0.3-1.8) developed HIV-1 between 6 weeks and 6 months, whereas 2.4% (95% CI, 1.3-3.6) of controls developed HIV-1.
“Six weeks, 14 weeks and 28 weeks of the drug nevirapine given to the infant can reduce HIV transmission, but it is not known whether there are cumulative benefits of giving the drug for an extended period of time,” Hoosen Coovadia, MD, of the University of the Witwatersrand in South Africa, told Infectious Disease News.
Coovadia and colleagues assessed the safety and efficacy of 6 months of nevirapine in a phase 3, randomized, double blind, placebo-controlled trial (HPTN 046).
From June 19, 2008, to March 12, 2010, breast-feeding infants born to mothers with HIV-1 across four African countries were randomly assigned to nevirapine (n=762) or placebo (n=765) within 7 days of birth. Six weeks later, infants without HIV infection were randomly assigned to extended nevirapine prophylaxis or placebo until 6 months.
Serious adverse events occurred in 16% of infants given extended nevirapine and 15% of controls; the event itself, frequency of the event and mortality did not differ significantly between groups, according to the researchers.
“Public policy can now revitalize the failing rates of breast-feeding in developing countries by making breast-feeding the default position for all women, with special attention given to HIV-positive women who may wish to use current prophylaxis (extended-dose nevirapine or maternal highly active antiretroviral therapy) to reduce vertical transmission of HIV,” Coovadia said.
Disclosure: The research was funded by the US National Institutes of Health.
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