Nevirapine Not Recommended for HIV Prevention After Needle Sticks, CDC Reports

The CDC yesterday advised physicians not to prescribe the "standard HIV prevention drug" nevirapine to healthy health care workers accidentally stuck by needles, citing the drug's adverse effect of severe liver damage, the New York Times reports. Nevirapine is recommended, however, to treat individuals infected with HIV and to prevent vertical transmission of HIV from mothers to their infants during birth, with the different recommendations based on the "relative benefits and risks" of the drug. Although CDC hospital infection expert Dr. Julie Gerberding explained that there are no studies showing nevirapine to be effective in preventing HIV infection following needle sticks, the drug's perceived ability to "act faster" than others and requirement of only one dose for vertical transmission prevention may encourage doctors to prescribe it. No serious adverse effects have been found in vertical transmission studies with nevirapine, and UNAIDS supports the CDC's recommendation for using the drug to prevent such transmission, as the "benefit outweighs the risks." While the risk of HIV infection from needle sticks is "real," it is also "low," and may not warrant the drug's risk of potentially fatal conditions. From March 1997 to September 2000, the CDC and the FDA identified 22 cases of severe liver, skin and muscle damage related to the use of the drug after possible exposure to HIV (Altman, New York Times, 1/5). However, as reporting such cases to the government is voluntary, the CDC acknowledges that there "undoubtably have been other cases" (McClam, AP/Akron Beacon Journal, 1/5). Each year, the General Accounting Office reports 236,000 needle stick injuries in American hospitals, and 56 health care workers have been documented with HIV infection from such injuries. When a worker is stuck with a needle believed to contain contaminated blood, the CDC recommends a four-week course of an anti-HIV medication other than nevirapine, but many physicians nonetheless prescribe the latter drug in these cases, CDC AIDS program director Dr. Helen Gayle said. Neviraprine is not approved by the manufacturer for use in preventing transmission through needle stick injuries, according to a spokesperson for Boehringer Ingelheim Corporation, which markets the drug under the trade name Viramune. The CDC also does not recommend the prescription of the drug to prevent HIV infection among people who may have been exposed to it via unsafe sex (New York Times, 1/5).