Nevirapine (Molecule of the Month for May 2007)
Viramune, NNRTI, HIV, AIDS
Nevirapine (trade name Viramune) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection and AIDS. When HIV infects a cell, reverse transcriptase copies the viral single stranded RNA genome into a double-stranded viral DNA. The viral DNA is then integrated into the host chromosomal DNA which then allows host cellular processes, such as transcription and translation to reproduce the virus. RTIs block reverse transcriptase's enzymatic function and prevent completion of synthesis of the double-stranded viral DNA thus preventing HIV from multiplying.
As with other antiretroviral drugs, HIV rapidly develops resistance if nevirapine is used alone, so recommended therapy consists of combinations of three or more antiretrovirals. Nevirapine in triple combination therapy has been shown to suppress viral load effectively when used as initial antiretroviral therapy.
A single dose of nevirapine given to both mother and child reduced the rate of HIV transmission by almost 50% compared with the normal zidovudine (AZT) prophylaxis regimen, in a clinical trial in Uganda. These and other trials have led to the adoption of nevirapine prophylaxis in some developing countries as a cost-effective way of reducing mother-to-child transmission. The U.S. Public Health Service Task Force, however, advocates caution in the use of nevirapine in pregnancy due to toxicity issues, which may be exacerbated during pregnancy. Another concern with this approach is that NNRTI resistance mutations are commonly observed in both mothers and infants after single-dose nevirapine, and may compromise the response to future NNRTI-containing regimens. A short course of maternal zidovudine/lamivudine is recommended by the U.S. Public Health Service Task Force to reduce this risk.
Formal Chemical Name (IUPAC)
Update by Karl Harrison
(Molecule of the Month for May 2007 )