Better Way to Save Babies from HIV

Nevirapine drug plus standard zidovudine reduces risk of babies getting HIV from moms

(RxWiki News) Pregnant women with HIV can take an antiretroviral regimen to lower the risk of giving their babies HIV. But what about women who don't know they have HIV until they give birth?

A recent study in the New England Journal of Medicine found that giving these newborns an additional drug called nevirapine considerably reduces the baby's risk of contracting HIV.

"Get tested for HIV early in your pregnancy."

Karin Nielsen-Saines, MD, of the School of Medicine at the University of California, Los Angeles, led the extensive study with 26 colleagues in the US, Argentina, Brazil and South Africa.

The researchers wanted to find the most effective drug combination for preventing transmission of HIV to babies during the birthing process.

The study involved 1,684 babies whose mothers were diagnosed with HIV just before or during labor. The babies were formula-fed to ensure HIV was not transmitted through breast milk.

The babies were split into three groups in their first two days after birth. One group (566 babies) received zidovudine only, a standard drug treatment, for six weeks. A second group group received zidovudine for six weeks but also received three doses of nevirapine in their first eight days following birth.

The third group received zidovudine for six week in addition to nelfinavir and lamivudine for two weeks. The researchers then assessed how many babies across the groups tested positive for HIV at three months old.

A total of 93 (5.7 percent) of the babies contracted HIV from their mothers while they were in the womb, regardless of which group they were in.

Among the babies who received zidovudine, 4.8 percent (24 babies) tested positive for HIV at three months while only 2.2 percent (11 total) of the babies who received zidovudine and nevirapine tested positive for HIV from their mothers.

For the babies treated with the three drugs, 2.4 percent (12 total) tested positive for HIV.

The researchers found that the children of mothers who had a higher viral load or who used illegal drugs, as well as those who received only the zidovudine drug, were more likely to contract HIV.

The researchers found a lower level of toxicity for the two drugs (zidovudine with nevirapine) than for the three-drug combination. Neutropenia, a blood disorder that results from too few white blood cells, occurred less among the nevirapine babies than the three-drug babies.

The use of zidovudine with nevirapine is also less expensive and easier to give the newborns than taking the three drugs.

"Pregnant women who don't know they have HIV or those who don't come in for prenatal care may not get the early treatment needed to keep the virus from being passed on to the baby," said co-author Heather Watts, MD, of the Pediatric, Adolescent and Maternal AIDS Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

"Our findings show that even in these situations, many, many infant cases of HIV can be prevented with the two drug combination treatment," Dr. Watts said. "The two-drug combination is relatively easy to administer and well tolerated by the babies."

The study appeared in the June 21 issue of the New England Journal of Medicine. The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health.

Review Date: 
June 20, 2012