Essential Medicines News

Investigators found that waiting for six months to start nevirapine-based antiretroviral therapy can help to prevent drug resistance in HIV-positive women who took a dose of nevirapine during labor in effort to prevent perinatal transmission of the virus.

Because it may not be safe to delay the initiation of antiretroviral treatment for 6 months or more post partum in women with advanced AIDS, initiation of non–nevirapine-based regimens should be considered for women starting antiretroviral treatment within 6 months after receiving a single dose of nevirapine. Furthermore, exposure to a single dose of nevirapine followed by nevirapine-based antiretroviral treatment was associated with high rates of virologic failure in the small group of infants that we studied.

Every effort should be made to provide antepartum combination antiretroviral treatment to women who qualify for antiretroviral treatment for their own health, since these are the women at highest risk for AIDS-related complications or death, for transmitting HIV to their infants, and for the development of nevirapine resistance after a single dose of nevirapine. However, single-dose nevirapine (with or without additional antiretroviral agents) remains an important component of the global strategy for the prevention of mother-to-child transmission of HIV-1 in women who do not yet qualify for antiretroviral treatment and for areas where treatment is not available. Our finding that women with more remote exposure to a single dose of nevirapine have high rates of virologic suppression in response to nevirapine-based antiretroviral treatment is reassuring for the many women who have received a single dose of nevirapine and to those who will receive it.

Also see the articles from NIH and the New York Times.