Using Nevirapine More Effectively
A study published in the January 11th issue of found that for mothers given a single dose of nevirapine during labor to reduce the chance of HIV transmission to their children, waiting six months after birth before taking a nevirapine-based antiretroviral treatment dramatically reduced their chances of developing resistance to nevirapine.
The use of single-dose nevirapine has successfully reduced mother-to-infant transmission of HIV, but with a significant drawback. Research has shown that 20 to 69 percent of women who take a single dose of nevirapine during labor subsequently develop resistance to the drug – a situation that may undermine the patients’ ability to respond later to nevirapine-containing antiretroviral therapy. And nevirapine, or a closely related drug that shares the same resistance, is used for almost all AIDS treatment in Africa. A single dose of nevirapine during labor is frequently all that is accessible to pregnant women in resource-limited settings where more expensive treatments multi-drug treatments are not available.
The team of researchers led by Shahin Lockman, Assistant Professor in the Department of Immunology and Infectious Diseases at Harvard School of Public Health and at Brigham and Women’s Hospital, and Max Essex, Chair of the Harvard AIDS Initiative, followed 218 HIV-infected women who received a single dose of nevirapine during labor, as well as a short treatment of anti-retroviral drugs during pregnancy. Sixty women started a nevirapine-based treatment within six months of giving birth, while the remaining 158 women started on the drugs six months afterward.
The outcomes were dramatically different. Of those women taking the drugs soon after giving birth, 41 percent experienced treatment failure. Of those women who waited, just 12 percent had the treatment fail.
Dr. Lockman speculated the better results were because the amount of nevirapine-resistant HIV in the body decreases as time passes from the single-dose exposure to nevirapine during labor. The findings will affect treatment approaches during pregnancy for millions of HIV-infected mothers.
In 2001 the Government of Botswana, in an initiative unprecedented in Africa, announced that it would provide antiretroviral (ARV) therapy free of charge to all qualifying patients. At that time, few physicians in Botswana had experience prescribing ARV drugs.
That same year the Botswana Ministry of Health, in collaboration with the Botswana-Harvard AIDS Institute Partnership, established the KITSO AIDS Training Program. KITSO was developed to train doctors, nurses and other health professionals to implement Botswana’s ambitious goals in a sustainable, standardized national ARV treatment program.
In 2002 the first four ARV treatment sites were opened. Today 32 main treatment sites are operating throughout the country. From its inception, KITSO-BHP has carefully incorporated monitoring and evaluation methods to assess the quality and integrity of the program’s structure, content and implementation. This commitment to constant evaluation has helped to create a program that is capable of adapting quickly to new research information and changing national public health guidelines.
The central course in KITSO’s training program is AIDS Clinical Care Fundamentals, which includes lectures, case study discussions, practice exercises for pediatric ARV dosing, question and answer sessions, and a final exam. Other courses include Medication Adherence Counseling, and Advanced HIV/AIDS Care and Treatment.
KITSO’s training of over 5,000 health professionals has supported Botswana’s national program, which now provides ARV therapy to over 80,000 patients and serves as a model for HIV/AIDS care and treatment throughout Africa.
KITSO-BHP’s training efforts are made possible through the support of the African Comprehensive HIV/AIDS Partnerships (ACHAP), a collaboration between the Government of Botswana, the Bill and Melinda Gates Foundation, and The Merck Company Foundation/Merck & Co., Inc.