Further reading on nevirapine resistance

14 July 2005. Related: Pregnancy.

Polly Clayden, HIV i-Base

Three studies from Johnson et al, Flys et al and Eshleman et al, looking at nevirapine resistance and persistence which we covered in our HTB CROI report are published in the Journal of Infectious Diseases. [1, 2, 3]

These are accompanied by an editorial commentary from Scott Hammer entitled (and in danger of becoming the new nevirapine resistance catch phrase): “The more you look the more you find”, in which he provides an overview of the more recent data and its implications. [4]

And in the Journal of Acquired Immune Deficiency Syndrome, Kagaayi et al report an encouragingly low rate of transmission (7.5%) and high rate of adherence to maternal (85.2%) and infant (84.8%) self administered nevirapine doses in an underserviced rural setting in Rakai, Uganda, with considerable and readily accessible community support. [5]

The authors write: “Mothers can be empowered to self-medicate themselves and their newborns and to reduce perinatal HIV infection. In circumstances where access to or utilisation of supervised delivery care is poor, as is the case in most rural areas of sub-Saharan Africa, there is an urgent need to replicate this study in a more conventional service setting.” These results are consistent with those reported in a trial setting and conflict with less efficacious results from a field setting such as those reported from Mombasa. [6]

It seems there will be an urgent need to replicate this level of success with more complex interventions in the near future.

References:

1. Johnson J, Li Jin-fen, Morris L et al. Emergence of drug-resistant HIV-1 after intrapartum administration of single-dose nevirapine is substantially underestimated. J Infect Dis 2005;192:16-23.
2. Flys T, Nissley D, Claasen CW et al. Sensitive drug resistance assays reveal long-term persistence of HIV-1 variants with the K103N nevirapine (NVP) resistance mutation in some women and infants after the administration of single dose nevirapine: HIVNET 012. J Infect Dis 2005;192:24-29.
3. Eshleman SH, Hoover D, Chen S et al. Nevirapine (NVP) resistance in women with HIV-1 subtype C, compared with subtypes A and D, after the administration of single dose nevirapine. J Infect Dis 2005;192:30-36.
4. Hammer SM. The more you look, the more you find. J Infect Dis 2005;192:1-3.
5. Kagaayi J, Dreyfuss ML, Kigozi G et al. Maternal self-medication and provision of nevirapine to newborns by women in Rakai, Uganda. J Acquir Immune Defic Syndr. 2005. 39: 121-124.
6. Quaghebeur A, Mutunga L, Mwanyumba F, et al. “Low efficacy of nevirapine (HIVNET012) in preventing perinatal HIV-1 transmission in a real-life situation”, AIDS. 2004 Sep 3;18(13):1854-6
   http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15316350&query_hl=3
   The article can be found on the AEGiS site at
   http://www.aegis.org/pubs/i-base/2005/IB050607-19.html