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Nevirapine Dosing Studied in Breast-Feeding Moms with HIV

Duration of therapy may need to be extended to prevent transmission of HIV via breast milk

FRIDAY, July 25 (HealthDay News) -- In HIV-infected mothers, risk of HIV transmission to their uninfected breast-feeding infants may be reduced by a prolonged postpartum course of nevirapine, according to an article published in the July 26 issue of The Lancet.

Robert C. Bollinger, M.D., of the Johns Hopkins School of Medicine in Baltimore, and colleagues randomized 2,024 infants of HIV-infected women who were breast-feeding to receive either single-dose nevirapine or six-week extended-dose nevirapine (1,047 infants in the single-dose group and 977 infants in the extended-dose group) and compared HIV infection rates at 6 months of age.

The investigators found that at 6 months of age, 87 children in the single-dose group and 62 in the extended-dose group were infected with HIV. They also report that 54 children in the single-dose group and 25 in the extended-dose group were HIV-positive at 6 weeks of age. In addition, 393 infants in the single-dose group and 346 in the extended-dose group experienced grade 3 or 4 serious adverse events, the report indicates.

"Although a six-week regimen of daily nevirapine might be associated with a reduction in the risk of HIV transmission at six weeks of age, the lack of a significant reduction in the primary endpoint -- risk of HIV transmission at six months -- suggests that a longer course of daily infant nevirapine to prevent HIV transmission via breast milk might be more effective where access to affordable and safe replacement feeding is not yet available and where the risks of replacement feeding are high," the authors conclude.

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