Original articles

Nevirapine plasma concentrations in premature infants exposed to single-dose nevirapine for prevention of mother-to-child transmission of HIV-1

Pierre Mugabo, Ilse Els, Johan Smith, Helena Rabie, Peter Smith, Mark Mirochnick, Wilhelm Steyn, David Hall, Richard Madsen, Mark F Cotton


Background. No pharmacokinetic data exist for premature infants receiving single-dose nevirapine (sd NVP) for prevention of mother-to-child transmission (MTCT) of HIV.
Aim. To describe NVP decay pharmacokinetics in two groups of premature infants – those whose mothers either received or did not receive NVP during labour.

Methods. Infants less than 37 weeks’ gestation were prospectively enrolled. Mothers received sd NVP during labour. Infants received sd NVP and zidovudine. Blood was collected on specified days after birth and NVP concentrations were determined by liquid chromatography-mass spectrometry.
Results. Data were obtained from 81 infants, 58 born to mothers who received sd NVP during labour (group I) and 23 to mothers who did not receive NVP (group II). Of the infants 29.6% were small for gestational age (SGA). Median (range) maximum concentration (Cmax), time to reach maximum concentration (Tmax), area under the plasma concentration-time curve (AUC) and half-life (T½) were 1 438 (350 - 3 832) ng/ml, 25h50 (9h40 - 83h45), 174 134 (22 308 - 546 408) ng/h/ml and 59.0 (15.4 - 532.6) hours for group I and 1 535 (635 - 4 218) ng/ml, 17h35 (7h40 - 29h), 168 576 (20 268 - 476 712) ng/h/ml and 69.0 (22.12 - 172.3) hours for group II. For group II, the median (range) volume of distribution (Vd) and body clearance (Cl) were 1 702.6 (623.7 - 6 189.8) ml and 34.9 (6.2 - 163.8) ml/h. The AUC was higher (p=0.006) and Cl lower (p<0.0001) in SGA infants. Plasma concentrations exceeding 100 ng/ml were achieved over 8 days in 78% infants in group I and 70.0% in group II. The MTCT rate was 4.8%.
Conclusion. Women in preterm labour often deliver with little advance warning. Our study suggests that NVP dosing of preterm infants as soon as possible after birth without maternal intrapartum dosing may be as effective as combined maternal and infant dosing.

Authors' affiliations

Pierre Mugabo, University of the Western Cape

Ilse Els, Stellenbosch University

Johan Smith, Stellenbosch University

Helena Rabie, Stellenbosch University

Peter Smith, University of Cape Town

Mark Mirochnick, Boston University

Wilhelm Steyn, Stellenbosch University

David Hall, Stellenbosch University

Richard Madsen, Uinversity of Missouri

Mark F Cotton, Stellenbosch University

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Nevirapine, Pharmacokinetics, Premature Infants, HIV

Cite this article

South African Medical Journal 2011;101(9):655-658.

Article History

Date submitted: 2011-02-17
Date published: 2011-09-05

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