Use of a single dose of nevirapine monotherapy may be enough to narrow future
treatment options for women with HIV, a number of UK HIV specialists warned
today, as US researchers announced that a single dose of nevirapine for mother
and child had cut HIV transmission by 47% when compared with a four week course
of AZT before delivery.
Dr Mervin Tyrer of the Royal Free Hospital warned that in his clinical
experience, the K103N mutation associated with nevirapine resistance could
emerge after a single exposure to the drug. He cited a case seen recently in
which a treatment-naïve woman who opted for the HIVNET 012 (single dose) regimen
was subsequently found to have the K103N mutation.
"Given that recent data suggest equivalence between NNRTI-containing regimens
and PI-containing regimens for people starting treatment, there is a danger that
women's future options could be compromised if they opt for what appears to be a
convenient regimen."
Dr Graham Taylor of St Mary's Hospital, London said that nevirapine
monotherapy would not replace the existing standard of treatment recommended in
the British HIV Association guidelines for antiretroviral therapy in pregnancy.
Where maternal therapy is indicated, he said, HAART remains the best option. In
women with low viral load and high CD4 counts, AZT monotherapy from week 14 of
pregnancy and a caesarean section is proven to reduce transmission rates below
2%. In comparison, the HIVNET 012 study demonstrated a transmission rate of 13%
in the nevirapine monotherapy arm.
A complete overview of current treatment options during pregnancy can be
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