E-DRUG NEVIRAPINE OR PLACEBO?
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After the fever of good news about Nevirapine is over, it would be
interesting to
know the mechanism by which it prevents HIV maternal-fetal transmission. If
you may recall for AZT study, in the group where maternal transmission was
prevented by AZT (67%), the protective effect due to reduction of HIV titre
could
be explained in only 9-17%. This indicated that we don't know the mechanism
by which AZT reduces maternal-fetal transmission of HIV. Perhaps a placebo
effect. As the AZT study was also case controlled, it would be a placebo
without the mind.
Since I have doubt that the HIV titre could have been brought under control
by a
few doses of Nevirapine (as opposed to a recommended dose 200 mg qid X 14
days), I am obliged to think of the placebo effect. Maybe Nevirapine, a non-
nuclease inhibitor, has a stronger placebo effect than AZT? Oh no, there is
something I had forgotten, the half-life of Nevirapine is 25-30 hrs versus
that 1.1
hrs for AZT. This would explain the difference in effectiveness and the
price. So,
is for the prolonged placebo effect. Can anyone help?
Best regards,
Prof. Andrew Walubo
UOVS
waluboa@frm.uovs.ac.za
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