Nevirapine to prevent mother-to-child transmission of HIV-1 among women of unknown serostatus.

Abstract

Each year about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless few women have access to MTCT-prevention services. In the more than 3 years since its inception the donation programme has shipped only 189 000 courses of the drug a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (authors)