HIV Drug nevirapine prevents infection but results in drug-resistant HIV

Maryland, United States, January 19: Although antiretroviral drug nevirapine is considered to be helpful in preventing infections from HIVdefine-positive mothers to their babies through breast-feeding, the new study claims that the drug increases the chances of developing drug-resistant HIV in infants if they get infected with the virus during the first year of life.

However, the team of investigators highlights the efficacy of the six-week course of the drug as the best therapy available to prevent mother-to-child HIVdefine infections via breast-feeding.

The study led by researchers at Johns Hopkins Children’s Center compared the risks of drug resistance in the first year of life in Indian infants getting a single dose of nevirapine at birth and those on the six-week regimen.

“While extended nevirapine prophylaxis dramatically reduces HIV transmission during the first six weeks of life, our data show that if infection does occur, it will most likely be with strains resistant to nevirapine, making HIV much harder to treat early with nevirapine,” stated senior investigator Deborah Persaud, M.D., a pediatric HIV expert at Hopkins Children's. “But until other interventions become available, the extended nevirapine regimen remains a reasonable way to prevent infections through breast-feeding.”

Nevirapine is better than nothing, feel the researchers. In public health programs, nevirapine is extensively used to prevent mother-to-child transmission of HIV worldwide.

The findings of the study, published in the Jan.1 issue of Public Library of Science One (PLoSOne), reveal that nevirapine therapy is one of the best ways to curb mother-to-child transmission of HIV in breast-fed infants in a developing world where bottle-feeding is too expensive, not safe or just not available.

Nevirapine or Viramune is an anti-viral drug used in combination with other medications to treat human immunodeficiency virus (HIV) infection in patients with or without acquired immunodeficiency syndrome (AIDS). The drug is relatively inexpensive and easy to administer.

Although the drug does increase the risk of death from HIV in infected infants, the benefits still outweigh the risk involved, commented the researchers. Because of the high risk for acquiring treatment-resistant HIV, the researchers call for the need to prescribe protease inhibitors (PIs) to infants in order to combat nevirapine-resistant HIV strains in them.

“In the developing world testing for resistance is not available or too expensive,” said Persaud, “so if extended nevirapine regimens become widespread, PIs should be made available as a first line of treatment early on for all infants who get infected despite prophylaxis.”

The researchers from Johns Hopkins Children’s Centre analyzed samples from 74 Indian babies infected with HIV before, during or after birth.

According to World Health Organization (WHO), one in ten breast-fed infants get HIV infection in the first 14 weeks of life. Despite the high risk of HIV transmission from mother-to-child, WHO strongly recommends breast-feeding for at least six months.

Earlier studies published in 2008 had revealed that a six-week treatment of antiretroviral drug nevirapine reduces the risk of HIV infection from breast-feeding to half, while a 14-week regimen reduces the risk by 66 percent.