 |
|
| Home | Course | Materials | UW Fogarty Programs | Partners | Events | Contact | |
Case Studies: Sam ClarkSam Clark |
Jonathan Gorstein - Abstract |
Jonathan Gorstein - Outline |
Anne Marie Kimbal |
Ann Kurth Nevirapine to Prevent Mother to Child Transmission of HIVAbstract The drug nevirapine can be used in single dose to the mother just before delivery and following delivery by 72 hours to the newborn to dramatically reduce the likelihood of transmission of HIV from HIV+ mothers to their newborn children – see url below titled “Nevirapine - godsend or a drug from hell?” [I do not agree with all the conclusions of this piece, but it is written by a reputable colleague who is knowledgeable.] The object of this treatment is to dramatically reduce the number of HIV+ babies born to HIV+ mothers. The treatment described above is comparatively cheap and easy and very effective. However, it has many potential problems that need to be carefully considered before endorsing widespread implementation of nevirapine monodose therapy to prevent mother to child transmission. The first of these is that this treatment has no particular benefit for the mother. The drug has few side effects, but this still raises an ethical question regarding whether or not it is acceptable to submit the mother to a treatment that does have some individual-level side effects if she gains nothing from it. Second is the fact that this regimen has a non-negligible likelihood of quickly selecting for nevirapine-resistant strains of HIV, and these strains may linger as a significant fraction of a treated woman’s viral load for a number of months after treatment. This timescale is long enough for her to recover from the birth and resume sexual relationships that may mediate the transmission of nevirapine-resistant strains to her partners. Further, it turns out that nevirapine is very similar to another drug efaverenz and both of these are used routinely to treat adult HIV+ individuals. Worse, resistance to one usually means resistance to both. So, the bad news is that nevirapine monodose therapy to prevent mother to child transmission may accelerate the spread of nevirapine/efaverenz-resistant strains of HIV in the general population. Third, what happens to young children whose mothers are HIV+? The answer is nothing nice, including the imminent loss of the mother. Orphans of any kind face dramatically higher risks of dying, and this goes for both the HIV+ and HIV- children who are born to HIV+ mothers. The unpleasant reality is that nevirapine monodose therapy will likely save the child from HIV in order to let it die of “orphanhood”. How do we decide what to do? Disciplinary Basis Public Health, Medicine, Demography, Sociology, Law (justice, philosophy?) Learning Objectives ? See: Nevirapine - godsend or a drug from hell?
|
