Mass treatment with nevirapine to prevent mother-to-child transmission of HIV/AIDS in sub-Saharan African countries.
OBJECTIVE
In 2001, an estimated 800000 children were newly infected with HIV, almost all through mother-to-child transmission (MCTC), and 90% of these children were born in Africa. In such resource-poor settings, cheaper and more easily administered antiretroviral drugs should be available for use. Mass treatment of an intrapartum and neonatal single dose of nevirapine regimen has been suggested as an effective strategy to prevent MCTC, yet this strategy has never been conducted in clinical trials. By discussing the advantages and disadvantages of it, we analyze the possibility of implementing this regimen.


METHODS
We reviewed public health strategies to prevent MCTC in resource-poor settings, and discuss whether or not mass treatment of an intrapartum and neonatal single dose of nevirapine regimen can be recommended as one therapy in sub-Saharan Africa due to its simplicity of distribution and use, long-term efficacy, and cost-effectiveness.


RESULTS
Recent studies in Uganda showed the high efficacy and cost-effectiveness of a single dose of nevirapine only to HIV/AIDS-positive pregnant women. The characteristics of nevirapine also meet the requirements of mass treatment. Mass treatment of nevirapine would increase access to antiretroviral drugs among pregnant women because they can access nevirapine without volunteer counseling and testing, which 31% of pregnant women in developing countries refused to accept due to the fear of stigmatization. No serious adverse effects or drug resistance to this regimen were reported through the studies in Uganda.


CONCLUSIONS
Mass treatment of a single-dose nevirapine can be recommended as one alternative therapy, and further research is recommended to obtain more information about the efficacy, side-effects, drug resistance, and compliance of this strategy.
Hashimoto
Hiroyuki
H
Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. jolly@pc4.so-net.ne.jp
Kapiga
Saidi Hussein
SH
Murata
Yuji
Y
D000328:Adult; D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019829:Nevirapine / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious
D019380:Anti-HIV Agents; D019829:Nevirapine