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Timing of maternal and neonatal dosing of nevirapine and the risk of mother-to-child transmission of HIV-1: HIVNET 024*

Chi, Benjamin Ha,b; Wang, Leic; Read, Jennifer Sd; Sheriff, Muhsine; Fiscus, Susanf; Brown, Elizabeth Rc,g; Taha, Taha Eh; Valentine, Meganj; Goldenberg, Roberta,b

Epidemiology and Social

Objective: Despite a growing emphasis worldwide on complex and potent antiretroviral drug regimens for the prevention of mother-to-child transmission of HIV-1 (MTCT), two-dose nevirapine (NVP) prophylaxis remains an important choice in many settings. We analyzed data from a multicenter clinical trial to determine whether timing of maternal or infant NVP was associated with MTCT between delivery and 6 weeks of age (intrapartum/early postnatal transmission; I/EP).

Methods: HIVNET 024 was a placebo-controlled, double-blind trial of empiric antibiotics to reduce chorioamnionitis-associated MTCT. This secondary analysis used data collected in the original randomized trial. Enrolled women were instructed to self-administer NVP at labor onset; infants were to receive a dose within 72 h of birth.

Results: Data regarding 1491 mother–infant pairs were analyzed. The overall I/EP HIV-1 transmission rate was 8.1% at 6 weeks. Almost all women (93%) ingested NVP within 24 h of delivery; 90% of infants were given NVP within 48 h after delivery. Variations in mother or infant dose timing did not influence transmission rates, even when the combined pattern of both was taken into account through multivariate analysis. In the subset of women ingesting NVP ≤ 2 h before delivery, early NVP administration to the infant (< 4 h after birth) was not associated with lower MTCT risk when compared with later administration (≥ 4 h).

Conclusion: Variations in the timing of maternal and infant NVP doses (within reasonable proximity to delivery) do not appear to affect the risk of MTCT.

From the aUniversity of Alabama at Birmingham, Department of Obstetrics & Gynecology, Birmingham, Alabama, USA

bCentre for Infectious Disease Research in Zambia, Lusaka, Zambia

cStatistical Center for HIV/AIDS Research and Prevention (SCHARP), Seattle, Washington

dNational Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA

eMUCHS–Harvard Research Collaboration, Dar-es-Salaam, Tanzania

fUniversity of North Carolina, Department of Microbiology and Immunology, Chapel Hill, North Carolina

gUniversity of Washington, Department of Biostatistics, Seattle, Washington

hJohns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland

jFamily Health International, Durham, North Carolina, USA.

Received 8 June, 2005

Revised 9 August, 2005

Accepted 18 August, 2005

* See Appendix.

Correspondence to Dr. Benjamin Chi, Box 34681, 5977 Benakale Road, Lusaka, Zambia. E-mail: bchi@cidrz.org

© 2005 Lippincott Williams & Wilkins, Inc.