- BOSTON (Reuters Health) -
HIV-infected women given a single dose of the anti-AIDS drug nevirapine
during labor to prevent them from transmitting the virus to their baby
harbor HIV in their breast milk that is resistant to the drug, according
to the results of a small clinical trial.
-
- The most common mutation found in the new study is associated
with resistance to all other drugs in nevirapine's class, a team of researchers
from California and Africa report. This could mean that the women are at
risk of transmitting drug-resistant disease to their infants through breast
milk.
-
- Dr. Constance A. Benson of the University of Colorado
Health Science Center in Denver, who did not participate in the study,
said the findings don't warrant a change in policy. In settings where health
care resources are scarce, she explained, the benefits of giving laboring
HIV-positive women nevirapine to prevent their baby from becoming infected
probably still outweigh the risks.
-
- Dr. John Mellors of the University of Pittsburgh, Pennsylvania
agreed. "To change policy based on these data would be a very big
mistake."
-
- The concentration of drug-resistant virus in breast milk
was significantly higher than levels detected in the blood, Dr. E. Lee
of Stanford University in Palo Alto noted here at the 10th Conference on
Retroviruses and Opportunistic Infections on Wednesday.
-
- Lee and colleagues at Stanford and at the University
of Zimbabwe, Harare, followed HIV-infected women in Chitungwiza, Zimbabwe,
who participated in a study in which they received a single dose of nevirapine
at the onset of labor.
-
- The women were subsequently monitored for HIV levels
in plasma, the cell-free portion of the blood, and breast milk at two,
eight, 16 and 20 weeks after delivery. Complete information was available
for plasma samples and breast milk samples for 33 and 20 women, respectively.
-
- After eight weeks, mutations in breast milk associated
with nevirapine resistance were detected in 13 of the 20 women (65%), while
such mutations were found in plasma in eight of the 33 women (40%). Four
infants had confirmed HIV infection.
-
- The most common mutation the researchers found is known
to confer resistance to other drugs in the same class of drugs as nevirapine,
known as non-nucleoside reverse transcriptase inhibitors.
-
- All of the women were infected with a type of HIV known
as subtype C. Whether these findings can
- be generalized to other HIV subtypes must be confirmed.
-
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