Results of a study from Malawi in this week's issue of THE LANCET highlight how antiretroviral therapy targeted at babies soon after childbirth (because their mothers' HIV diagnosis was made around the time of delivery) is still effective in preventing vertical HIV-1 transmission from mothers to their children.

Zidovudine and nevirapine have been shown to reduce mother-to-child transmission of HIV in breastfeeding women in Africa; treatment is usually initiated late in pregnancy and continued until early infancy. Taha E Taha from Johns Hopkins Bloomberg School of Public Health, USA and colleagues assessed whether nevirapine and zidovudine given to babies only reduced HIV-1 transmission more than nevirapine alone.

Over 1100 babies of Malawian women with HIV-1 who presented late (within 2 hours of expected delivery) were randomly assigned either nevirapine alone or nevirapine and zidovudine. Both drugs were given immediately after birth. Infant HIV infection was determined at birth and at 68 weeks.

The rate of mother-to-child transmission at 68 weeks was lower among babies given combination therapy (around 15%) than those given nevirapine alone (around 21% transmission rate). Of babies who were HIV-1 negative at birth, 7.7% of babies given combination therapy were HIV-1 positive at 6-8 weeks compared with 12.1% of babies given nevirapine alone (a protective efficacy of 36%).

Taha E Taha comments: "Postexposure prophylaxis could be a way of reaching babies of women who missed opportunities to be counselled and tested before or during pregnancy. The combined regimen of nevirapine and zidovudine that we studied is easy to implement and might be a candidate for wider use to prevent transmission of HIV from mothers to babies. In settings such as sub-Saharan Africa where most women arrive to the labour room without knowledge of their HIV status, and are too late to receive intrapartum nevirapine, a practical approach would be to test cord b
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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
9-Oct-2003

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