A drug called nevirapine has been shown to be effective in reducing the risk of transmission of HIV at birth, but combination therapy of nevirapine and zidovudine does not improve outcomes, according to a study published in the current HIV/AIDS Journal of the American Medical Association.
Taha E. Taha, M.B.B.S., Ph.D., of the Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, presented the findings of the study at the International AIDS Conference in Bangkok, Thailand.
Background information suggests that pre-birth counseling and human immunodeficiency virus (HIV) testing are not universal in Africa; thus, women often present in labor with unknown HIV status without receiving the standard HIVNET 012 nevirapine (NVP) regimen (a single oral dose of NVP to the mother at the start of labor and to the infant within 72 hours of birth). Information on the efficacy of adding zidovudine (ZDV) to a standard regimen of NVP is limited. This information is needed because most women in sub-Saharan Africa do not receive pre-birth antiretroviral treatment.
The researchers hypothesized that in situations in which the mother is tested for HIV at the time of presentation for delivery, giving two short drug regimens to the infant at birth would be more effective in increasing viral suppression and thus reducing mother-to-child transmission of HIV than a single regimen.
Dr. Taha and colleagues conducted a randomized trial between April 1, 2000, and March 15, 2003 at six clinics in Blantyre, Malawi, Africa. The trial included all infants born to 894 women who were HIV positive, received NVP intrapartum (during labor and delivery), and had not previously received antiretroviral treatment. Infants were randomly assigned to NVP single oral dose (n=448) and NVP (same dose) plus ZDV (n=446) for a week. Infants were enrolled at birth, observed at 6- to- 8 week visits, and followed up through 3 to 18 months. The investigators established the HIV status of 90 percent of all infants at 6 to 8 weeks.