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Maternal HIV - a new approach

12th November 2007

A new study has pointed to a possible new cocktail of HIV drugs that could reduce the risks associated with treating HIV-positive mothers who are pregnant.

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Until now, pregnant, HIV-positive women are offered a drug called niverapine during labour in the hope that it will protect the baby from acquiring the virus during childbirth.

However, there is a risk that, if the drug doesn't work, that both mother and baby can develop a drug-resistant strain of the HIV virus, which is much harder to treat.

But a recent clinical trial in Zambia, published in The Lancet, has offered a possible solution.

The study of 397 HIV-positive pregnant women showed that one group of 199 women who were given two other drugs alongside niverapine and zidovudine at or around the time of birth, fared better than a group who only took niverapine and zidovudine, known as AZT.

Led by Benjamin Chi of the Centre for Infectious Disease Research in Zambia and University of Birmingham in Alabama, the study found that women given the cocktails of HIV drugs were 53% less likely to develop higher resistance to the other classes of drugs, which are known as non-nucleoside reverse transciptase inhibitors (NNRTIs).

The group which developed less of the drug-resistant strain than the control group was given two NNRTIs - tenfovir and emtricitabine - as well as niverapine and zidovudine.

The absolute risk of developing drug-resistant HIV was cut in half: 12% for the test group, and 25% for the control group.

While some serious adverse events were reported - postpartum anaemia for mothers, and pneumonia for the infants - in both groups, this was not thought to have been caused by the new drug mixture.

In a comment also published in The Lancet, Shahin Lockman and James McIntrye of the Harvard School of Public Health in Boston said the results provided strong evidence that adding single-dose tenofovir/emtricitabine" to standard treatments was a new, effective, and feasible approach to reducing maternal nevirapine resistance.



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