I work for an access to medicines non-profit, so this book is an interesting look at all the various steps required to get a drug to the people who need it. It is a very academic book--I can see it being taught in global health classes--but is not easy to get through as a layperson.

"I was given an early review copy of the book in exchange for an honest review. A very ambitious book; dense with information. Overall, it covers about 25 years of AIDS and treatment. Although Nevirapine is the drug in the title of the book, and is the AIDS drug most closely followed, the disease itself and the use of other drugs in the management of the disease are also discussed.
The book has chapters on how a chemist isolates a compound, how early testing in the lab is done, how to ramp up the manufactur of a drug for clinical trials, and what goes in to clinical trials internationally. The book also focuses attention of Africa, in particular South Africa, and the continuing proliferation of AIDS on that continent.
This reads like a textbook, and does jump around in subject matter. The author wants to capture everything. Despite the title, it's only in the last pages that the reader discovers that better drugs have been invented, and Neviripine is being sunsetted as the drug of choice for AIDS maternal - infant transmission." ( )

This book tells an important story. Unfortunately it is not told very well. The author jumps back and forth in time in a confusing manner and doesn't really have an organized concept for the reader to follow. This is not an easy book to read.

On the other hand, the author does a good job of explaining just how complex, time-consuming and frustrating it is to develop and market a new drug. The author also does a good job of portraying just how much of a team effort modern drug development is. It's not a matter of a lone scientist shouting "Eureka" in her lab; many people contribute to the development of drugs and most of them are not recognized on patents. The challenges of fulfilling the various requirements of different countries is also laid out. I also really appreciated the generous number of pictures of people who contributed to the development and distribution of the drug.

I wish this book had been better organized and written in a more engaging manner, but it definitely can serve as a good reference book for those interested in the topic. ( )

Rebecca Anderson is a freelance technical writer, medical school professor and pharmacologist who previously worked in drug development for several companies, including Boehringer Ingelheim Pharmaceuticals, which discovered nevirapine (trade name: Viramune), an antiretroviral drug that demonstrated excellent activity against human immunodeficiency virus (HIV). Anderson used her personal knowledge of nevirapine and her contacts at Boehringer Ingelheim (BI) to write this interesting and informative book about the discovery, development and use of this drug, which is described in the larger context of the development of HIV/AIDS drugs, drug development from an insider's standpoint, and the history of pediatric AIDS in the US and Africa.

The book opens with the story of Ariel Glaser, the four year old daughter of the American actor Paul Michael Glaser, who starred in the 1970s television detective series "Starsky and Hutch", and Elizabeth Glaser, who contracted HIV from a blood transfusion she received in 1981 while she gave birth to Ariel. She later became a vibrant and determined AIDS activist who was a key figure in the push to develop antiretroviral drugs for children in the United States and Africa, and after her death the foundation renamed in her honor continues to support research into and implementation of AIDS treatment in the US, Africa and China.

The discovery of nevirapine as a potent antiretroviral agent began in the 1960s, as chemists at Boehringer Manheim painstakingly synthesized hundreds of compounds in an effort to find one that decreased the production of stomach acid and treated peptic ulcers. After one compound was chosen for this purpose the remaining ones were stored in a facility, where they sat for two decades until BI decided to study them to see if any demonstrated activity against HIV. Remarkably, one compound did work well, and the discovery of this prototype led to the development of similarly structured compounds, and the one that demonstrated the greatest efficacy in chemical assays (in vitro) and in living subjects (in vivo) and bioavailability (the amount of a drug that remains active and available in the body after its administration) was chosen for development; it was subsequently given the name nevirapine.

Although nevirapine wasn't the first antiretroviral drug to be used in adults or children with HIV/AIDS, it proved to be a potent agent when used by itself or in combination with other drugs such as AZT, ddI and ddC. Despite numerous studies demonstrating this, its use in the US and particularly in Africa was impeded by several factors, including the challenges of designing trials to test for efficacy and adverse effects in human subjects, particularly children, the extensive process required for new drugs to be approved for use in the US, and the reluctance of some countries, most notably and tragically South Africa under the Thabo Mbeki administration, to provide it to its citizens. The book closes with a summary of the state of antiretroviral drug development, and a tribute to the researchers and activists who were instrumental in the development of nevirapine and to several notable survivors of childhood HIV/AIDS.

Anderson provides technically detailed descriptions of the development and testing of nevirapine by BI, along with the studies and implementation of this agent, which I found to be quite educational but may prove to be a challenge to the average reader, although one which would be worthwhile in my opinion.

Nevirapine and the Quest to End Pediatric AIDS is a valuable and highly recommended contribution to the ongoing story of HIV/AIDS and to the history of medicine and drug development and implementation, told from the largely unbiased standpoint of a pharmaceutical researcher who was closely involved in this account. ( )

Anderson's examination of Nevirapine is actually an account of quite a bit more than a single drug's creation. Beyond the scope of the title, Anderson also examines the tangle of research and researchers that began attempting a combat against AIDS from the very beginning of the disease's stranglehold. Discussing the full range of researchers, clinical trials, setbacks, and false starts, Nevirapine and pediatric AIDS are far in the background of the book for much of her examination. Details, throughout, are instead made the focus. On one hand, this puts much needed attention on the complexity of not only HIV/AIDS, but on the difficult process of finding a cure or treatment for any illness. Readers interested in this process will find a lot to admire in Anderson's early chapters, particularly if they're interested in the details of the science behind what has to happen in order for any treatment to reach an adequate stage of presentation and use. Unfortunately, readers uninterested in the science, or without any background in medical literature, HIV/AIDS research, or science may well find themselves left behind and unable to follow Anderson's text without outside support. As a result, the book simply isn't for every reader. Without an interest in science or a background in similar texts, this would be an incredibly difficult read.

That said, this book does take up the challenge of exploring what other texts on HIV/AIDS have left uncovered. Especially in the second half of the work, Anderson devotes real attention to examining the specific challenges (and differences) associated with combatting pediatric illnesses as opposed to adult illnesses, including a close look at why so much more attention is often focused onto adult treatment. Just as impressively, Anderson focuses real attention on HIV/AIDS in Africa, both on the political and social ramifications of the virus and its treatment, and on the specific difficulties of complicated medical treatments in developing countries. Here, especially, Anderson's research and discussion excels, for most books which have taken a similar look at HIV/AIDS have steered clear of a close look at HIV/AIDS' proliferation in other countries.

In the end, though the work is more detailed than many readers would wish--especially in terms of science, research, and politics--and also far larger in scope than its title would suggest, it is also a worthwhile read for interested readers, particularly those who want a larger look at the long-range path toward sustainable HIV/AIDS research and associated difficulties. Unfortunately, readers who do want a specific look at particular aspects of the text will have to search for the relevant material. Though the book reads something like a textbook, it set up as more of a narrative, and chapter titles don't do much to suggest each chapter's focus. Research is an important thread throughout the work, but it's worth noting that the first third of the book pays little focus to the specifities of pediatric treatment, and that the last third of the work is where Anderson closes her attention on treatment and HIV/AIDS in Africa, as well as on pediatric treatment alone.

All together, this isn't for the casual reader. But, for readers like myself who already have a familiarity with the history (scientific and cultural) of HIV/AIDS and its treatment, the book does hold something new to offer in terms of detail and focus. ( )