American Journal of Obstetrics & Gynecology
Volume 197, Issue 3, Supplement , Pages S56-S63, September 2007

Use of single-dose nevirapine for the prevention of mother-to-child transmission of HIV-1: does development of resistance matter?

  • Michelle S. McConnell, MD

      Affiliations

    • Thailand–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
    • Division of Global AIDS, Centers for Disease Control and Prevention, Atlanta, GA
    • Corresponding Author InformationReprints: Michelle S. McConnell, MD, TUC, Ministry of Public Health, Tivanon Road, Nonthaburi, 11000, Thailand.
    • ,
  • Jeffrey S.A. Stringer, MD

      Affiliations

    • Schools of Medicine and Public Health, University of Alabama at Birmingham, Birmingham, AL
    • ,
  • Athena P. Kourtis, MD, PhD, MPH

      Affiliations

    • Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • Paul J. Weidle, PharmD, MPH

      Affiliations

    • Division of HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA
    • ,
  • Susan H. Eshleman, MD, PhD

      Affiliations

    • Johns Hopkins University, Baltimore, MD.

Received 15 December 2006; accepted 26 February 2007.

Nevirapine resistance has been detected in a considerable proportion of women after single-dose nevirapine (SD-NVP) for the prevention of mother-to-child human immunodeficiency virus–1 transmission. As a result, concern has been raised about the effectiveness of subsequent nevirapine-based treatment. Studies in Thailand, Botswana, and South Africa have assessed virologic treatment response after SD-NVP. These studies did not find any significant difference in virologic response for women who began treatment >6 months after SD-NVP exposure. Two studies found worse response rates in women when treatment was initiated within 6 months of SD-NVP exposure. Furthermore, 2 studies found no difference in human immunodeficiency virus transmission rates from mother to child after the receipt of SD-NVP in repeat pregnancies. These data support the use of SD-NVP as 1 option for the prevention of mother-to-child human immunodeficiency virus–1 transmission in resource-limited settings, particularly in settings where more complex regimens are not yet available. Further research in the optimization of perinatal prevention regimens is needed.

Key words: nevirapine, PMTCT, resistance, treatment

 

 The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the US Centers for Disease Control and Prevention.

PII: S0002-9378(07)00267-0

doi:10.1016/j.ajog.2007.02.031

American Journal of Obstetrics & Gynecology
Volume 197, Issue 3, Supplement , Pages S56-S63, September 2007