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Delay in use of nevirapine-based AIDS treatment can improve outcomes

Boston, MA -- Delaying the use of nevirapine-containing antiretroviral therapy (ART) for at least six months after labor may improve treatment outcomes among HIV-infected women in developing countries who took nevirapine during labor to prevent their babies from becoming infected, suggests a new study in The New England Journal of Medicine. The findings could potentially change treatment approaches for millions of mothers infected with the AIDS virus. The study appears in the January 11, 2007, issue of the journal.

Nevirapine, given once during labor, either alone or in combination with a short course of zidovudine (AZT) or other antiretroviral medications, significantly reduces the chances that a pregnant woman will pass HIV to her child. A single dose of nevirapine during labor is frequently all that is accessible to pregnant women in resource-limited settings where more complicated and expensive, multidrug treatments may not be available.

The use of single-dose nevirapine has successfully reduced mother-to-infant transmission of HIV, but has also created a terrible dilemma for physicians and patients. Research has shown that 20 to 69 percent of women who take a single dose of nevirapine during labor subsequently develop resistance to the drug -- a situation that may undermine the patients" ability to respond later to nevirapine-containing ART when they may need the treatment to save their lives. Nevirapine is the cornerstone of three-drug ART in most regions of the world. Drug resistance develops as well in a range of the minority of infants who become HIV infected, despite the use of single-dose nevirapine.

Now, a team of researchers led by Shahin Lockman, Assistant Professor in the Department of Immunology and Infectious Diseases at Harvard School of Public Health (HSPH) and at Brigham and Women's Hospital, and Max Essex, chair of the HSPH AIDS Initiative, has conducted a study that suggests a potential solution to this problem.
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Contact: Christina Roache
croache@hsph.harvard.edu
617-432-6052
Harvard School of Public Health
10-Jan-2007


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