Pregnancy

Nevirapine (Viramune) is safe for use in pregnant women.1 2 However, the use of nevirapine in pregnant women poses an elevated risk of liver toxicity, which has been fatal to mothers and foetuses.3 4 There is also evidence that blood levels of nevirapine are reduced in pregnant women, which may increase chances of developing resistance.5

Treatment with nevirapine during labour has also been shown to reduce mother-to-baby transmission of HIV.6  Later studies have demonstrated that single doses of nevirapine during labour, with or without a dose for the infant after birth can further reduce the risk of transmission when added to a course of zidovudine treatment.7 8 However, maternal exposure to nevirapine compromised subsequent triple therapy including nevirapine, even in women who did not have detectable NNRTI resistance.9 10 11 12 Consequently, in February 2004, the World Health Organization recommended that short-course regimens of nevirapine monotherapy not be used when standard regimens are available. This was due to the risk of nevirapine resistance and because zidovudine in combination therapy reduced transmission to a greater extent than nevirapine alone.13

References

  1. Mirochnick M et al. Pharmacokinetics of nevirapine in human immunodeficiency virus type 1-infected pregnant women and their neonates. Pediatric AIDS Clinical Trials Group Protocol 250 Team. J Infect Dis 178: 368-374, 1998
  2. Marazzi MC et al. Safety of nevirapine-containing antiretroviral triple therapy regimens to prevent vertical transmission in an African cohort of HIV-1-infected pregnant women. HIV Med 7: 338-344, 2006
  3. Hitti J et al. Maternal toxicity with continuous nevirapine in pregnancy: results from PACTG 1022. J Acquir Immune Defic Syndr 36: 772-776, 2004
  4. Timmermans S et al. Nelfinavir and nevirapine side-effects during pregnancy. AIDS 19: 795-799, 2005
  5. Haberl A et al. Nevirapine plasma exposure is decreased in pregnant women. 15th International AIDS Conference, Bangkok, abstract TuPeB4644, 2004
  6. Guay LA et al. Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. The Lancet 354: 795-802, 1999
  7. Taha TE et al. Short postexposure prophylaxis in newborn babies to reduce mother-to-child transmission of HIV-1: NVAZ randomised clinical trial. The Lancet 362: 1171-1177, 2003
  8. Lallemant M et al. Single-dose perinatal nevirapine plus standard zidovudine to prevent mother-to-child transmission of HIV-1 in Thailand. N Engl J Med 351: 217-228, 2004
  9. Jourdain G et al. Intrapartum exposure to nevirapine and subsequent maternal responses to nevirapine-based antiretroviral therapy. N Engl J Med 351: 229-240, 2004
  10. Jackson JB et al. Identification of the K103N resistance mutation in Ugandan women receiving nevirapine to prevent HIV-1 vertical transmission. AIDS 14: F111-F115, 2000
  11. Eshleman SH et al. Selection and fading of resistance mutations in women and infants receiving nevirapine to prevent HIV-1 vertical transmission (HIVNET 012). AIDS 15: 1951-1957, 2001
  12. Cunningham CK et al. Development of resistance mutations in women receiving standard antiretroviral therapy who received intrapartum nevirapine to prevent perinatal human immunodeficiency virus type 1 transmission: a substudy of pediatric AIDS clinical trials group protocol 316. J Infect Dis 186: 181-188, 2002
  13. Moodley D et al. Evaulation of safety and efficacy of two simple regimens for the prevention of mother to child transmission (MTCT) in HIV infection: nevirapine vs lamivudine and zidovudine used in a randomised clinical trial (the SAINT study). 13th International AIDS Conference, Durban, abstract TuOrB356, 2000
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.