Post-natal ARV prophylaxis for infants: efficacy of extended nevirapine.
Article Type: Brief article
Subject: Disease transmission (Research)
Disease transmission (Prevention)
HIV infection (Drug therapy)
HIV infection (Research)
Infants (Health aspects)
Nevirapine (Health aspects)
Nevirapine (Research)
Pub Date: 05/01/2011
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2011 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2011 Source Volume: 19 Source Issue: 37
Topic: Event Code: 310 Science & research
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 259077155
Full Text: Daily infant nevirapine given for six or 14 weeks or six months to breastfeeding HIV-exposed infants reduces mother-to-child transmission (MTCT) compared to single-dose NVP; however, the incrementai benefit of extending prophylaxis to six months has not been evaluated. This randomised, placebo-controlled, double-blind trial was undertaken in South Africa, Tanzania, Uganda and Zimbabwe. Between 2007 and 2010, 1,522 HIV-negative infants of HIV-positive mothers were given daily nevirapine from birth to age six weeks, when they were randomised to receive extended nevirapine (759 infants) or placebo (763 infants) until they were six months old. At the rime of randomisation, 29% of mothers were on ARV therapy for their own health in each arm. At three months, 95% of infants in each arm were exclusively breastfed; >90% of infants stopped breastfeeding between six and nine months, with no difference between arms (p=0.93).

Extending daily infant nevirapine to six months lowered the risk of HIV infection at age six months, most significantly when their mothers had CD4 counts [greater than or equal to] 350 and were not on treatment themselves. After age six months, infection rates and mortality risk were similar between the arms, but 2/3 of deaths occurred after age six months (after most infants had stopped breastfeeding). There was no significant difference in adverse events or serious adverse events between arms. These data support the benefits and safety of extended infant nevirapine for women who do not yet require or cannot access ARVs for their own health. (1)

(1.) Coovadia H, Brown E, Maldonado Y, et al. HPTN 046: 18th Conference on Retroviruses and Opportunistic Infections, Boston, abstract 123LB, 2011.
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