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Date Posted: 20:26:40 07/24/02 Wed
Author: moonotter
Subject: With Maternal ART, Peripartum Nevirapine Does Not Lower HIV Transmission Risk Further

With Maternal ART, Peripartum Nevirapine Does Not Lower HIV Transmission Risk Further




By Megan Rauscher
NEW YORK (Reuters Health) Jul 09 - In HIV-infected pregnant women receiving prenatal care and standard antiretroviral therapy (ART) with elective cesarean section available, the risk of HIV transmission is low and there is no demonstrable benefit of adding intrapartum/newborn nevirapine therapy.

This finding, from the International Pediatric ACTG 316 Team, is reported in The Journal of the American Medical Association for July 10th. "Based on studies conducted in women who breastfeed their infants and are on no other antiretroviral therapy, it was anticipated that the two-dose intrapartum/newborn nevirapine regimen would provide an additional benefit in interrupting perinatal HIV transmission," Dr. Coleen K. Cunningham told Reuters Health. But that was not the case.

In the study, the researchers treated 1270 nonbreastfeeding women receiving ART with 200-mg oral nevirapine or placebo after the onset of labor. Their newborns received 2-mg/kg oral nevirapine 48 to 72 hours after birth.

The trial was halted early because of the low overall transmission rate (1.5%). "The very fact that overall transmission rates are so low would not have been predicted from previously available data," Dr. Cunningham, from the State University of New York Upstate Medical Center, noted.

"Most striking," she said, "is the fact that the two-dose nevirapine regimen did not lower transmission rates even in the women at highest risk of HIV transmission, based on high HIV RNA and low maternal CD4." The team believes that the frequent use of antenatal highly active ART and the fact that 34% of women elected to deliver by c-section are reasons for the low transmission rates observed.

The majority (53%) of the perinatal transmissions noted in the study occurred in utero and therefore would be unaffected by this intrapartum regimen, the authors say.

The researchers think this two-dose intrapartum/newborn nevirapine regimen could prevent HIV infection in "many" children in developing countries where antepartum ART is not available. But in the presence of ART and elective c-section it is not worthwhile.

JAMA 2002;288:189-198.




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Reuters Health Information 2002. © 2002 Reuters Ltd.
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