Moms Need to Be Cautious

Women given the HIV prevention drug nevirapine to protect their fetus should not use an HIV-drug regimen that contains nevirapine for at least one year after childbirth, say researchers at the University of Alabama at Birmingham.

A new UAB study found that while nevirapine works well to prevent mother-to-child HIV transmission, a single dose of nevirapine in infected pregnant women can trigger resistance to some forms of the AIDS-drug cocktail known as combination antiretroviral treatment. This nevirapine-induced resistance fades after about 12 months and no longer hinders ART, says UAB professor of Obstetrics and Gynecology Jeffrey S.A. Stringer, MD, the study's lead author.

The findings are published in PLoS Medicine, a journal of the nonprofit Public Library of Science. Single-dose nevirapine is widely used to prevent mother-to-child transmission of HIV, an infection that affects more than 30 million people globally and leads to more than 2 million AIDS-related deaths each year.

"This study shows that women who need treatment more than 12 months after using nevirapine to prevent mother-to-child transmission safely can use standard first-line treatments in their countries," says Stringer, director of the UAB-affiliated Center for Infectious Disease Research in Zambia. "Women who need treatment sooner than that should use a combination that does not contain nevirapine, typically an ART regimen that contains protease-inhibitor drugs."

The UAB study included 878 infected women in Zambia, Cote d'Ivoire and Thailand. Some were given single-dose nevirapine and others were not; all participants were given ART immediately upon confirmed infection and monitored for one year.

Nevirapine continues to be the backbone of anti-HIV therapy in the developing world, and its usefulness in preventing mother-to-child transmission is confirmed in the new study, Stringer says.

The research is a collaboration between several partners: UAB; the U.S. Centers for Disease Control and Prevention Division of HIV/AIDS Prevention and Global AIDS Program; the Centers for Infectious Disease Research in Lusaka, Zambia; the Catholic Medical Missions Board; the Lusaka Urban District Health Management Board; the University of Nairobi; Siriraj Hospital and Rajavithi Hospital in Bangkok; the Thailand Ministry of Public Health; and Northrop Grumman Corp. Funding support for the study is provided by the CDC.

The UAB Department of Obstetrics and Gynecology provides comprehensive care for every stage of life -- from routine gynecologic care, to childbirth, to menopause and beyond. Its physicians are leaders in their fields in a nationally ranked program dedicated to giving patients the best care available.