WHO issues guidelines on Nevirapine

Amid concerns that South Africa would phase out an anti-AIDS drug preventing the transmission of HIV from seropositive mothers to their children, the World Health Organisation (WHO) has released new guidelines on the use of antiretroviral (ARV) treatment for pregnant women. The UN health agency on Wednesday said the guidelines, 'Antiretroviral Drugs for Treating Pregnant Women and Preventing HIV Infection in Infants', "took into account the most recent information on the safety and effectiveness of different drug regimens, as well as concerns over resistance to some of the drugs, including Nevirapine". In a controversial move South Africa's Medicines Control Council this week announced that the use of Nevirapine as a monotherapy would be phased out and the drug would be used only in combination, as HIV-positive mothers could be developing a resistance to the drug. But WHO said concerns about resistance needed to be balanced with the "simplicity and practicality" of delivering single-dose Nevirapine, compared with other regimens. Studies have shown that a dose of Nevirapine given to infected pregnant women during labour, followed by a dose given to the newborn baby, can reduce transmission of HIV by up to 50 percent. "Antiretroviral prophylaxis using single-dose maternal and infant Nevirapine remains a practical alternative when provision of more effective regimens is not feasible. Progress in implementing programmes to prevent mother-to-child transmission, based on single-dose maternal and infant Nevirapine or other short-course regimens, should not be undermined," WHO said in statement. The health agency underscored that although single-dose maternal and infant Nevirapine was the simplest regimen to deliver, treatment programmes should consider introducing one of the other recommended regimens where possible. It recommended using combinations of drugs called Zidovudine, Lamivudine and Nevirapine. WHO highlighted that the use of Zidovudine from 28 weeks of pregnancy plus single-dose Nevirapine during labour, with single-dose Nevirapine and one week of Zidovudine for the infant, had proven highly effective. The agency added that new research being presented at the current 15th International AIDS Conference in Bangkok, Thailand, could offer a way of reducing resistance observed shortly after delivery. About 100,000 babies are born HIV-positive each year in South Africa and more than five million people are infected, giving it the world's highest AIDS caseload.