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The newspaper of The Johns Hopkins University October 13, 2003 | Vol. 33 No. 7
Drugs to Newborns Block HIV Infection from Moms

By Kenna Brigham
School of Public Health

Antiretroviral therapy given to babies after birth offers protection against HIV infection, according to researchers from the Johns Hopkins Bloomberg School of Public Health. They found that a regimen of nevirapine and zidovudine is 36 percent effective in blocking the transmission of HIV from mother to child.

The researchers also report that giving these drugs to babies after birth is easier to administer when compared to giving antiretrovirals to mothers during pregnancy. Their study, "Short post-exposure prophylaxis in newborn babies to reduce mother-to-child transmission of HIV-1; NVAZ randomized clinical trial," is published in the Oct. 11 issue of The Lancet.

Lead author Taha El Tahir Taha, associate professor in the Department of Epidemiology, with a joint appointment in the Department of Population and Family Health Sciences, explained that nevirapine is typically given to mothers prior to delivery and to the baby after birth to prevent mother-to-child transmission of HIV. In Sub-Saharan Africa, most women arrive at medical facilities only a few hours before delivery and with an unknown HIV status, making it difficult to counsel them and test for HIV.

"These factors limit the use of nevirapine before delivery. Another approach to prevent transmission of the disease is clearly necessary," he said. "In this study, we've shown that exposure after birth to prophylaxis with nevirapine and AZT can reduce mother-to-child transmission of HIV."

The researchers studied babies from 1,119 Malawian women with HIV-1 who presented late for delivery to determine if treatment with a combination of nevirapine and zidovudine as compared to a regimen of nevirapine alone reduced transmission of the disease. Infant HIV was tested at birth from cord blood samples and at six to eight weeks.

At the six-to-eight-week mark for babies who were HIV negative at birth, the protection rate was 7 percent for the 484 babies who received nevirapine and zidovudine and 12 percent for the 468 babies who received nevirapine only. The net reduction of overall mother-to-child transmission was 5 percent. These results are comparable to rates observed in studies in South Africa and Uganda, where antiretroviral drugs were given to both mother and infant.

The researchers also explain in their study that a regimen of nevirapine and zidovudine is easily given orally to babies immediately after birth: a single dose of nevirapine followed by zidovudine twice a day for seven days. Giving postexposure prophylaxis only to the baby is also easier than giving antiretrovirals to pregnant women and their newborns, especially in areas where resources are scarce.

Taha said, "When it is not possible to give intrapartum nevirapine to the mother, it is still beneficial to give the intervention to the baby after birth. The baby will be afforded additional protection by receiving a second antiviral drug. With these new, promising results, we believe that alternative drugs may also be used as safety data become available. These regimens could also be extended to prevent transmission of HIV through breast milk."

Newton I. Kumwenda and Amanda Gibbons, both with the School of Public Health, co-authored the study.

Research was supported by grants from the Fogarty International Center, National Institutes of Health and the Doris Duke Charitable Foundation.


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