A new drug therapy could help ease a terrible dilemma that has forced HIV-positive mothers to gamble with the well-being of their unborn children, as well as their own, a new study reported on Wednesday.
Up to now, pregnant women infected with HIV or Aids and their doctors faced a terrible choice.
A single dose of the drug nevirapine during labour reduced the chances of the infant inheriting the deadly virus by 40%.
But if the newborn still became infected despite the drug, the child was far more likely to acquire a strain of the virus that was resistant to the medications most commonly used to treat HIV, raising the question of whether it was worth the risk.
There was an increased chance that the same resistant virus would develop in the already infected mothers.
A partial solution to this cruel choice now seems to be at hand, according to the study, published in the British journal the Lancet.
In a clinical trial, 199 of 397 HIV-infected pregnant women who sought care at two public sector health facilities in Lusaka, Zambia, were given single doses of two other drugs — tenofovir and emtricitabine — along with the nevirapine during birth.
All three drugs are known as non-nucleoside reverse transcriptase inhibitor drugs, or NNRTIs.
The second group of 198 soon-to-be-mothers were given only the nevirapine, as has been standard practice.
Both groups also took a short course of a fourth drug, zidovudine, better known as AZT.
The researchers, led by Benjamin Chi of the Centre for Infectious Disease Research in Zambia and University of Birmingham in Alabama, found that women given the four-drug combination were 53% less likely to develop higher resistance to NNRTIs six weeks after delivery.
The absolute risk 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, none were judged to be caused by the new drug mixture.
These results ”provide strong evidence that adding single-dose tenofovir/emtricitabine” to standard treatments ”is a new, effective, and feasible approach to reducing maternal nevirapine resistance”, noted Shahin Lockman and James McIntrye of the Harvard School of Public Health in Boston in the Lancet. – AFP
