WHO publishes guidance on preventing mother-to-child transmission of HIV
A regimen of zidovudine from 28 weeks of pregnancy plus a single-dose of nevirapine during labour is highly effective in preventing mother-to-child transmission of HIV, according to recent guidelines
published by the World Health Organization.
The WHO recommends that such prophylaxis should be offered to women who
are not receiving antiretroviral treatment, either because it is not
indicated or because they do not have access to treatment. Other regimens
based on zidovudine alone, zidovudine plus lamivudine or single-dose
nevirapine alone are also recommended. The latter regimen is not ideal,
however, and an alternative regimen should be used where possible.
The WHO acknowledges the problems of drug resistance associated with
short-course regimens but stresses that they should be used where provision
of more effective regimens is not feasible.
The guidance comes as further evidence emerges for this type of regimen.
Researchers in Thailand have shown that zidovudine treatment plus a single
dose of nevirapine reduces HIV transmission rates to 2.8 per cent compared
with 6.3 per cent for zidovudine plus placebo. When nevirapine was also
administered as a single dose to the infants after delivery, the rate
was further reduced to 1.9 per cent (New England Journal of Medicine 2004;351:217).
Another study reveals that a single dose of nevirapine during labour
is associated with less effective viral suppression during subsequent
antiviral treatment (ibid, p229). |
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