Drug reduces infants' HIV risk

$4 treatment touted for battle against AIDS in Third World

July 15, 1999|By Scott Shane and Diana Sugg | Scott Shane and Diana Sugg,SUN STAFF

American and Ugandan researchers have found that an inexpensive drug can dramatically reduce the chance that a mother will pass the AIDS virus to her baby, a discovery that could save the lives of as many as 1,000 newborns a day in the Third World.

The study, directed by Dr. Brooks Jackson of the Johns Hopkins School of Medicine and a Ugandan obstetrician, was hailed yesterday as a breakthrough in the search for an affordable weapon against AIDS in developing countries ravaged by the disease.

"It's very exciting, and for the first time provides us with a regimen that potentially could be applicable in most if not all countries," said Dr. Lynne Mofenson of the National Institute for Child Health and Human Development in Bethesda.

"This is phenomenal news," said Dr. Peter Vink, director of pediatric AIDS care and evaluations research at the University of Maryland School of Medicine. "When looking at sub-Saharan Africa, the next generation sounds almost doomed unless you can start dropping HIV transmission."

A $4 dose of the drug, called nevirapine, cut the number of infants infected with HIV to 13 percent, less than half the 30 percent or more who would be infected if no drug was given. The scientists said the nevirapine treatment is about 200 times less expensive than the standard course of the drug AZT given to HIV-infected mothers in the United States.

"This is so simple and cheap I think it will actually be implemented in developing countries," said Jackson, professor and vice chairman of Hopkins' pathology department. He said he found nevirapine, used to treat AIDS inadults since 1996, priced at $3.67 a dose in the Hopkins pharmacy.

When the study began three years ago, the researchers intended to compare nevirapine with a placebo. But after a 1998 study in Thailand showed that a one-month course of AZT -- costing 70 times more than nevirapine treatment -- cut the infection rate in babies by about half, researchers decided it would not be ethical to continue to give placebos.

In scientific studies, it is generally considered improper to give subjects suffering from a serious illness a placebo when a clearly effective treatment is available. Some AIDS studies in the Third World have come under fire for doing just that.

The Uganda study was revised to compare nevirapine with a short course of AZT, rather than with a placebo. Mothers got the drugs during labor and their babies got smaller doses after birth.

The results for the 618 mothers and infants reported yesterday were striking. When the babies were tested for HIV at the age of 3 months, only 13 percent of those in the nevirapine group were infected, compared to 25 percent in the AZT group.

Another advantage of nevirapine is that it can be taken orally rather than intravenously, said Dr. Marie McCormick, a professor at the Harvard School of Public Health who chaired a national committee on preventing perinatal transmission of HIV. "In situations with limited medical care, getting an IV in is not always easy," she said.

Doctors are studying the value of adding nevirapine to the current standard treatment for HIV-positive mothers in the United States. In addition, said McCormick, the simple nevirapine regimen could be an option for HIV-infected pregnant women who've had no prenatal care and show up at the hospital in labor.

The World Health Organization estimates that more than 700,000 babies are born each year infected with HIV in the developing world. If treatment with nevirapine could cut that number in half, it would prevent about 1,000 infants every day from developing AIDS.

But scientists cautioned that neither nevirapine nor any other drug tested so far can prevent the human immunodeficiency virus from being passed on during breast-feeding. That means some babies protected by nevirapine from infection might get the virus later.

The scientists said the data are preliminary, and they intend to continue to study the babies until the age of 18 months to see how many uninfected infants contract the virus through breast-feeding. Jackson said the average Ugandan mother breast-feeds for 14 or 15 months, though scientists believe the virus is most likely to be passed via breast milk in the first six weeks.

Costly combinations of drugs have dramatically improved the health and extended the lives of people with AIDS in the United States, where standard treatment has cut the rate of mother-to-child HIV transmission to 3 to 5 percent.

But such treatments are far too expensive for widespread use in the developing world, where about 95 percent of new HIV infections occur each year. Nearly 14 million people have died of AIDS worldwide and nearly 40 million are currently infected with HIV.

Vink compared the U.S. regimen to getting a whole orange, and the nevirapine strategy tried in Uganda to getting just a slice of an orange.

"It's great for developing countries, but we can afford more," Vink said. "If you lived here in Baltimore and walked in, I would not say we would go for only two pills."

Pub Date: 7/15/99

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