What We're Reading: Studies Published in NEJM Provide Guidance on Optimal Treatment for HIV-Positive Women and Infants
(Photo: Mia Collis)Two studies published yesterday in the
New England Journal of Medicine (NEJM) have provided greater guidance on the optimal HIV treatment for women and infants in order to avoid the effects of potential drug resistance.
The
OCTANE study followed HIV-positive women who had received a single dose of the antiretroviral drug nevirapine to prevent transmission of the virus to their babies,
and the P1060 study followed HIV-positive infants who had also received a single dose of nevirapine but had still become infected. Both studies investigated the effects of later using nevirapine as part of a triple-drug regimen for treatment of HIV infections.
The studies found that the drug’s efficacy was sometimes reduced compared to treatment with a regimen using a combination of the drugs lopinavir and ritonavir. These results appear to be caused primarily by the emergence of drug-resistance in HIV following exposure to single-dose nevirapine.
This resistance can be prevented or substantially reduced in frequency by administering triple antiretroviral therapy to pregnant women, or more effective combination regimens for prevention of mother-to-child transmission (PMTCT) such as a single dose of nevirapine with a “tail” of the drugs zidovudine and lamivudine to mothers around the time of delivery, rather than the single dose of nevirapine alone.
Notably, the studies suggest that HIV drug resistance to nevirapine does fade over time, since little difference in efficacy between the nevirapine and lopinavir/ritonavir treatment regimens was observed in mothers who were started on treatment more than 24 months after exposure to single-dose nevirapine.