3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

NEVIRAPINE CONCENTRATION IN CERVICO-VAGINAL AND OROPHARYNGEAL SECRETIONS IN A MOTHER-CHILD COHORT IN UGANDA

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPp0402

Kunz A.¹, Karcher H.¹, Mayer A.¹, Simo S.¹, Mugenyi K.², Kurowski M.³, Stocker H.³, Mashate S.², Harms G.^1
1 GTZ PMTCT Project/Institute of Tropical Medicine, Charité - University Medicine, Berlin, Germany, ² MoH/GTZ PMTCT Project Western Uganda, Fort Portal, Uganda, ³ Therapia Laboratories, Auguste-Viktoria Hospital, Berlin, Germany

INTRODUCTION: Nevirapine levels in secretions other than blood and breast milk have not been determined although sufficient drug concentrations may be of significant importance for protection from HIV mother to child transmission.

OBJECTIVES: To assess the distribution and concentration of nevirapine in cervico-vaginal secretions (CVS) of the mother and in oropharyngeal secretions (OPS) of the newborn after maternal intake of nevirapine.

METHODS: Specimens were collected from 51 mother-child pairs participating in a PMTCT programme in western Uganda. All mothers had taken a single 200 mg tablet of nevirapine. CVS was collected by immersing a filter paper strip (Sno strips, Chauvin, Kingston, UK) into the endocervix. OPS was collected from newborns immediately after birth using a mucus extractor (Medicoplast, Illingen, Germany). Venous blood from the mother and 2 ml cord blood from the newborn were collected in EDTA tubes. All specimens were taken 0.25 to 27 h after nevirapine intake by the mother but before the newborn had received nevirapine syrup. Drug levels were determined by liquid chromatography/tandem mass spectrometry. The cut off for nevirapine concentration was 20 ng/ml.

RESULTS: Nevirapine was detected in all CVS and in all OPS. Median plasma levels were 1680 ng/ml (range 569-4000) in the mother and 1315 ng/ml (range 114-2720) in the newborn. Significant correlations were found between nevirapine concentrations in plasma of mother and newborn (p< 0.01, r = 0.51), in plasma and OPS of the newborns (p< 0.05, r = 0.37) and in plasma of newborns and CVS (p< 0.05, r = 0.45).

CONCLUSIONS: Cervico-vaginal and oropharyngeal secretions contained high concentrations of nevirapine after single dose application to the mother. Nevirapine levels in these body compartments may contribute to the protective effect of the drug towards HIV mother to child transmission.

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050724
Clinical | TuPp0402 | Gundel Harms
Perinatal transmission

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