HIVNET nevirapine trials

Abstract

Sir—Although Laura Guay and colleagues’ (Sept 4, p 795) study on the effectiveness of nevirapine in reducing perinatal HIV-1 t r a n s m i s s i o n offers hope for reducing the enormous global toll of HIV-1 infection, their work remains deeply unethical. For 14 months after an antepartum and intrapartum regimen of zidovudine was shown in Thailand to reduce HIV-1 transmission by 51%, Guay and colleagues continued to enrol participants without providing antepartum antiretroviral drugs. This practice continued for 6 months after WHO had recommended antepartum and intrapartum zidovudine therapy in less developed countries “where adequate infrastructure is in place”, a condition certainly met in this study. Because the mothers were enrolled as early as 32 weeks’ gestation, there was ample opportunity to provide this lifesaving medication.