Babies born to mothers with HIV have a much smaller risk of getting the virus themselves if medical personnel administer preventive drugs, such as nevirapine, at birth to the moms and their newborns. Nevertheless, a small percentage of those infants will end up getting the disease anyway. And without treatment, some 62 percent of HIV-positive children die before the age of two.

One favored treatment approach up to now has been giving infants protease inhibitors that slow the virus's replication and help many young children with HIV stay healthier longer. However, the recommended ritonavir-boosted lopinavir treatment can be expensive—and the current liquid formulation has a nasty taste that many infants and toddlers are reluctant to swallow. It also needs to be refrigerated, which can be difficult in resource-poor areas, and its long-term toxicity has not been evaluated. Thus, scientists have been looking for a better alternative to treat youngest of the approximately 430,000 children worldwide who have HIV.

New research shows, however, that for HIV-positive babies whose infection has been stabilized, most will do just fine switching to a regime of nevirapine, a reverse transcriptase inhibitor, even if the infants had been exposed to the same drug at birth. The drug also has the bonus of costing about a fifth of the price of the protease inhibitor meds as well as not requiring refrigeration or tasting quite so icky, the researchers behind the new study noted.

The study, which followed 195 randomized babies and toddlers under 2 for a year, was published online September 7 in JAMA, Journal of the American Medical Association.

About two thirds of the children with HIV that had switched to the nevirapine were able to maintain a level of fewer than 50 copies of the virus per milliliter of blood. This was the lowest level the available technology could reliably detect and a vast improvement for more than half of the children who had had more than 750,000 copies per milliliters before starting treatment.

In fact, the many children who were switched to nevirapine did better than those who were kept on the more expensive protease inhibitors. The researchers noted in their paper, however, that they were not sure whether that was because the nevirapine was more effective or simply more palatable, thus garnering better adherence. But regardless of the reasons behind the results, switching young children to a longer-term reverse transcriptase inhibitor could be a great help for the young children for whom prophylactic nevirapine at birth did not prevent them from becoming infected.

"This allows treatment options for children to be expanded," Louise Kuhn, a professor of epidemiology at the Mailman School of Public Health at Columbia University and coauthor of the new study, said last week in a press briefing about the research.

Not all of the children who were switched to nevirapine kept their copy numbers down during the year of follow up. The team recommended monitoring viral loads and returning to protease inhibitors if necessary.

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