Two AIDS studies cause for hope, concern

Early success at stopping transmission to newborns

resistant strains spreading


BARCELONA, Spain - Findings of two new studies, one hopeful and the other a cause for concern, were released yesterday, the day before the opening here of the 14th annual International AIDS Conference.

Thai and U.S. health officials reported highly successful results in the first nationwide program in a developing country to try to prevent transmission of the virus that causes AIDS from a mother to her newborn.

The other report, from the University of California at San Francisco, says that a small but rising number of people in San Francisco are being infected with strains of HIV that are resistant to certain drugs commonly used to treat the infection.

In the Thai program - after pilot studies showed the benefits of the drug AZT in preventing transmission from mother to child in certain areas - the government mounted a program in October 2000 to reach the more than 500,000 women each year who give birth and the 10,000 infants a year who are born at risk of contracting HIV.

In the program's first year, more than two-thirds of HIV-infected pregnant women who had prenatal care received the recommended brief course of AZT as preventive treatment. Nearly 90 percent of the infants at risk also received the drug.

The findings "provide a beacon of hope" for extending Thailand's success to women and infants in other countries, said Dr. R.J. Simonds, an epidemiologist at the U.S. Centers for Disease Control and Prevention. Simonds worked on the project in Thailand from 1998 to 2001 and is a co-author, with Thai health officials, of a report to be published in the Journal of the American Medical Association.

It will be another year before health officials learn how many babies escaped HIV infection, but they say findings from the earlier pilot studies suggest that the rate of infection will be reduced by more than 50 percent.

Studies are under way to determine whether the addition of nevirapine or other drugs will increase the number of babies who are protected from infection.

In one such study by Thai doctors, reported from Bangkok on Friday by the Associated Press, another set of HIV-infected pregnant women was given a combination of AZT and nevirapine. The rate of transmission from mother to child dropped to less than 5 percent. Doctors emphasized, however, that results were preliminary.

In the San Francisco study, among patients who acquired resistant HIV, it took about 12 weeks for the amount of the virus in the blood to fall to desired levels, compared with four weeks among those with nonresistant virus, said Dr. Frederick M. Hecht, a co-author of the report.

Although the long-term significance of the difference in the resistance of the strain is not known, an implication is that such an infection may become more difficult to treat, Hecht said.

The findings should be a warning to those engaging in unsafe sex and other risky behaviors in the mistaken belief that newer drugs have made acquired immune deficiency syndrome an easily treatable disease, he said.

Dr. Merle A. Sande, an AIDS expert at the University of Utah, said the findings had important implications for Africa, where 25 million people are infected and where relatively small but growing numbers of people are beginning to be treated with combinations of powerful anti-HIV drugs. Sande, who also teaches doctors in Uganda how to use anti-HIV drugs, said doctors and African governments must adapt and change strategies to deal with the resistant strains.

The resistant strains in San Francisco were found from June 1996 through June 2001 among 225 patients who had become recently infected and who had never been treated for HIV.

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