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Antiretroviral therapy for prevention of mother-to-child HIV transmission : focus on single-dose nevirapine.
Clin Drug Investig. 2006; 26(11):611-27.CD

Abstract

Administration of potent antiretroviral combination therapy in the second and third trimester of pregnancy and during delivery, and for 6 weeks postpartum to the infant, may reduce HIV transmission from the mother to the child to <2% in formula-fed infants. In resource-constrained settings where women have limited access to antenatal care, use of shorter and more practical regimens, including nucleoside reverse transcriptase inhibitors (NRTIs) and/or non-NRTIs (NNRTIs) commenced later in pregnancy, has demonstrated efficacies ranging from 18% to 70% in breast- and bottle-fed populations. Because shorter interventions include regimens such as single-dose nevirapine or zidovudine monotherapy, which do not provide maximal suppression of viral replication, emergence of resistant mutations in mother and infant occurs frequently, primarily after exposure to drugs with low genetic barriers (i.e. those requiring only one genotypic mutation to develop resistance), such as nevirapine. Different studies have reported nevirapine resistance rates ranging from 25% to 69% in mothers receiving single-dose nevirapine alone. Because NNRTI-based combinations of antiretroviral agents are recommended as first-line therapy in countries where single-dose nevirapine is the main option for preventing mother-to-child transmission of HIV, concerns have been raised as to whether single-dose nevirapine prophylaxis can compromise the efficacy of subsequent NNRTI-based antiretroviral therapy regimens. However, although some studies have shown that nevirapine exposure may impact on short-term virological outcome, the clinical relevance of nevirapine resistance remains unclear, especially in women who start treatment >6 months after delivery or in those who are not severely immunocompromised. Furthermore, studies have shown that adding short-course (up to 7 days) zidovudine or zidovudine/lamivudine prophylaxis after delivery may dramatically reduce the occurrence of nevirapine resistance in both mothers and infants. Until data are available that allow a better understanding of the relevance of antiretroviral drug resistance acquired as a result of mother-to-child HIV transmission prophylaxis, women and children who have previously received single- dose nevirapine as part of a mother-to-child transmission prevention strategy should be considered eligible for NNRTI-based regimens and should not be denied access to antiretroviral therapy.

Authors+Show Affiliations

Dipartimento di Pediatria, Università di Padova, Padova, Italy. carlog@pediatria.unipd.itNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

17163296

Citation

Giaquinto, Carlo, et al. "Antiretroviral Therapy for Prevention of Mother-to-child HIV Transmission : Focus On Single-dose Nevirapine." Clinical Drug Investigation, vol. 26, no. 11, 2006, pp. 611-27.
Giaquinto C, Rampon O, De Rossi A. Antiretroviral therapy for prevention of mother-to-child HIV transmission : focus on single-dose nevirapine. Clin Drug Investig. 2006;26(11):611-27.
Giaquinto, C., Rampon, O., & De Rossi, A. (2006). Antiretroviral therapy for prevention of mother-to-child HIV transmission : focus on single-dose nevirapine. Clinical Drug Investigation, 26(11), 611-27.
Giaquinto C, Rampon O, De Rossi A. Antiretroviral Therapy for Prevention of Mother-to-child HIV Transmission : Focus On Single-dose Nevirapine. Clin Drug Investig. 2006;26(11):611-27. PubMed PMID: 17163296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antiretroviral therapy for prevention of mother-to-child HIV transmission : focus on single-dose nevirapine. AU - Giaquinto,Carlo, AU - Rampon,Osvalda, AU - De Rossi,Anita, PY - 2006/12/14/pubmed PY - 2007/1/4/medline PY - 2006/12/14/entrez SP - 611 EP - 27 JF - Clinical drug investigation JO - Clin Drug Investig VL - 26 IS - 11 N2 - Administration of potent antiretroviral combination therapy in the second and third trimester of pregnancy and during delivery, and for 6 weeks postpartum to the infant, may reduce HIV transmission from the mother to the child to <2% in formula-fed infants. In resource-constrained settings where women have limited access to antenatal care, use of shorter and more practical regimens, including nucleoside reverse transcriptase inhibitors (NRTIs) and/or non-NRTIs (NNRTIs) commenced later in pregnancy, has demonstrated efficacies ranging from 18% to 70% in breast- and bottle-fed populations. Because shorter interventions include regimens such as single-dose nevirapine or zidovudine monotherapy, which do not provide maximal suppression of viral replication, emergence of resistant mutations in mother and infant occurs frequently, primarily after exposure to drugs with low genetic barriers (i.e. those requiring only one genotypic mutation to develop resistance), such as nevirapine. Different studies have reported nevirapine resistance rates ranging from 25% to 69% in mothers receiving single-dose nevirapine alone. Because NNRTI-based combinations of antiretroviral agents are recommended as first-line therapy in countries where single-dose nevirapine is the main option for preventing mother-to-child transmission of HIV, concerns have been raised as to whether single-dose nevirapine prophylaxis can compromise the efficacy of subsequent NNRTI-based antiretroviral therapy regimens. However, although some studies have shown that nevirapine exposure may impact on short-term virological outcome, the clinical relevance of nevirapine resistance remains unclear, especially in women who start treatment >6 months after delivery or in those who are not severely immunocompromised. Furthermore, studies have shown that adding short-course (up to 7 days) zidovudine or zidovudine/lamivudine prophylaxis after delivery may dramatically reduce the occurrence of nevirapine resistance in both mothers and infants. Until data are available that allow a better understanding of the relevance of antiretroviral drug resistance acquired as a result of mother-to-child HIV transmission prophylaxis, women and children who have previously received single- dose nevirapine as part of a mother-to-child transmission prevention strategy should be considered eligible for NNRTI-based regimens and should not be denied access to antiretroviral therapy. SN - 1173-2563 UR - https://www.unboundmedicine.com/medline/citation/17163296/Antiretroviral_therapy_for_prevention_of_mother_to_child_HIV_transmission_:_focus_on_single_dose_nevirapine_ L2 - https://dx.doi.org/10.2165/00044011-200626110-00001 DB - PRIME DP - Unbound Medicine ER -