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Sci Tech
Relooking at single-dose nevirapine strategy, to cut drug resistance
Eight years after starting the programme of giving single-dose nevirapine to both mother and infant to cut the mother-to-child transmission (vertical transmission), the National AIDS Control Organisation (NACO) is having a relook at the monotherapy strategy.
Despite its ability to cut vertical transmission by 45-55 per cent, many studies have shown that single-dose nevirapine strategy is responsible for the emergence of drug resistance in both mother and infant.
The Pune based National AIDS Research Institute (NARI) is doing a feasibility study of using other drugs in addition to nevirapine to prevent mother-to-child transmission.
Single dose is given to HIV positive mothers at the time of delivery, and nevirapine syrup to infants immediately after birth to prevent mother-to-child transmission. The monotherapy strategy has been widely used in many developing countries.
According to a paper published in the Clinical Drug Investigation journal in 2006, single-dose nevirapine does not provide maximum suppression of viral replication, thereby leading to emergence of resistant mutations.
This is primarily because nevirapine requires just one genotype mutation to develop resistance.
Studies have also shown that adding short-course (up to 7 days) of other drugs reduces the occurrence of nevirapine resistance. Such combination drugs greatly reduce the chances of vertical transmission too.
But for the issue of drug resistance, using single dose of nevirapine is a more practical and a good strategy especially in resource constraint settings with limited access to antenatal care. — R.P.
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