Hashimoto Hiroyuki, Kapiga Saidi Hussein, Murata Yuji
Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
J Obstet Gynaecol Res. 2002 Dec;28(6):313-9. doi: 10.1046/j.1341-8076.2002.00062.x.
In 2001, an estimated 800000 children were newly infected with HIV, almost all through mother-to-child transmission (MCTC), and 90% of these children were born in Africa. In such resource-poor settings, cheaper and more easily administered antiretroviral drugs should be available for use. Mass treatment of an intrapartum and neonatal single dose of nevirapine regimen has been suggested as an effective strategy to prevent MCTC, yet this strategy has never been conducted in clinical trials. By discussing the advantages and disadvantages of it, we analyze the possibility of implementing this regimen.
We reviewed public health strategies to prevent MCTC in resource-poor settings, and discuss whether or not mass treatment of an intrapartum and neonatal single dose of nevirapine regimen can be recommended as one therapy in sub-Saharan Africa due to its simplicity of distribution and use, long-term efficacy, and cost-effectiveness.
Recent studies in Uganda showed the high efficacy and cost-effectiveness of a single dose of nevirapine only to HIV/AIDS-positive pregnant women. The characteristics of nevirapine also meet the requirements of mass treatment. Mass treatment of nevirapine would increase access to antiretroviral drugs among pregnant women because they can access nevirapine without volunteer counseling and testing, which 31% of pregnant women in developing countries refused to accept due to the fear of stigmatization. No serious adverse effects or drug resistance to this regimen were reported through the studies in Uganda.
Mass treatment of a single-dose nevirapine can be recommended as one alternative therapy, and further research is recommended to obtain more information about the efficacy, side-effects, drug resistance, and compliance of this strategy.
2001年，估计有80万儿童新感染艾滋病毒，几乎全部通过母婴传播（MCTC），其中90%的儿童出生在非洲。在这种资源匮乏的环境中，应提供更便宜且更易于使用的抗逆转录病毒药物。有人建议采用分娩时和新生儿单剂量奈韦拉平方案进行大规模治疗，作为预防母婴传播的有效策略，但该策略从未在临床试验中实施过。通过讨论其优缺点，我们分析实施该方案的可能性。
我们回顾了在资源匮乏环境中预防母婴传播的公共卫生策略，并讨论由于其分发和使用的简便性、长期疗效和成本效益，分娩时和新生儿单剂量奈韦拉平方案的大规模治疗是否可作为撒哈拉以南非洲的一种治疗方法推荐。
乌干达最近的研究表明，仅对艾滋病毒/艾滋病阳性孕妇使用单剂量奈韦拉平具有高效性和成本效益。奈韦拉平的特性也符合大规模治疗的要求。奈韦拉平的大规模治疗将增加孕妇获得抗逆转录病毒药物的机会，因为她们无需接受自愿咨询和检测就能获得奈韦拉平，而发展中国家31%的孕妇因担心被污名化而拒绝接受此类咨询和检测。通过乌干达的研究未报告该方案有严重不良反应或耐药性。
单剂量奈韦拉平的大规模治疗可作为一种替代疗法推荐，建议进一步研究以获取更多关于该策略的疗效、副作用、耐药性和依从性的信息。
