HIV Antiviral May Protect New Babies from Infection

By Portyansky, Elena | Drug Topics, March 3, 1997 | Go to article overview

HIV Antiviral May Protect New Babies from Infection


Portyansky, Elena, Drug Topics


On the AIDS battlefront the smallest victims may become better armed, thanks to new research tactics enlisting the support of Viramune (nevirapine, Boehringer Ingelheim). In these studies, the non-nucleoside reverse transcriptase inhibitor, already approved for adults, has shown potential in reducing mother-child HIV transmission, which is most prevalent during labor and delivery.

"The idea is to give one 200-mg nevirapine tablet to the mother at onset of labor, in order to provide prophylactic therapy to the baby as it passes through the birth canal and is exposed to the virus in maternal blood and vaginal secretions," said John Sullivan, M.D., professor of pediatrics, University of Massachusetts Medical School, who has been using the experimental therapy in his patients.

A 2-mg dose is also administered to the newborn between two and three days of age in the hope of preventing the newly introduced virus from establishing itself if infection from mother has occurred. This is "much like health-care workers who receive AZT for six weeks immediately after high-risk exposurewhich, according to the CDC [Centers for Disease Control & Prevention], has prevented 80% of HIV infections," remarked Sullivan. He added that nevirapine may even be stronger in this effect, although not yet proven.

Sullivan stressed the importance of using nevirapine along with AZT, which remains the standard of care in pregnancy. According to studies, the combination is expected to further reduce the chances of HIV transmission in infants, which has already fallen from 25% to 8% with the use of AZT alone. However, "the experimental regimen may also have a place in women who cannot tolerate AZT due to potential toxicities or simply are not compliant with therapy," Sullivan said.

If nevirapine is shown to be effective, Sullivan expects the inexpensive, twodose treatment (about $2) to be used in developing countries where AZT, which is started in the second trimester and continued throughout pregnancy, is not affordable and maternal HIV transmissions are on the rampage, reaching as high as 40%. …

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