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Bargain lifesaver

Bargain lifesaver

作者:万淫  时间:2019-03-07 03:19:06  人气:

By Nicole Johnston in Washington DC HUNDREDS of thousands of babies each year could be spared from starting life with HIV at a cost of just $4 each. That’s the startlingly hopeful conclusion from a study conducted in Uganda. More than 600 women with HIV took part in the trial. All were given an antiviral drug during labour, and their babies were treated with the same drug. Half the mothers and infants were given AZT, the other half a newer drug called nevirapine. Both interfere with the enzyme reverse transcriptase, without which HIV cannot replicate. “We were hoping nevirapine would be as good as AZT, but it turned out to be better,” says Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases (NIAID) near Washington DC, which sponsored the trial. In sub-Saharan Africa, between 25 and 35 per cent of babies born to women with HIV themselves become infected. In the group receiving AZT, 25.1 per cent were infected at around 15 weeks. But in the nevirapine group, the figure was just 13.1 per cent. Nevirapine also has the advantage that it crosses the placenta readily and breaks down slowly, so can be given in small doses. In the Ugandan trial, the women received a single dose of nevirapine during labour, and their babies were given another dose within three days of birth. AZT had to be given several times over several hours during labour, and twice a day to the infants for one week. These modest doses mean that developing countries should be able to afford nevirapine. In Europe and North America, AZT is often given to pregnant women with HIV over a period of months, cutting the rate of transmission to less than 10 per cent. But this costs more than $800. At just $4 per mother and child, the nevirapine treatment should be within the reach of countries that until now have had to give up on protecting their infants from HIV. And the NIAID is now even suggesting that the nevirapine treatment is so cheap that it could be given routinely to women in labour in developing countries experiencing severe HIV epidemics. But James McIntyre, director of the perinatal HIV research unit at the Chris Hani Baragwanath Hospital in Johannesburg, says this ignores the realities of health care in poor countries. “Only 50 per cent of women in developing countries deliver in a health service setting,” he says. McIntyre argues that health infrastructures need to be improved to offer all pregnant women tests for HIV so that they can be given the drug during labour if they are infected. The optimism about nevirapine and mother-to-child transmission of HIV comes hard on the heels of preliminary results suggesting that a simple drugs cocktail could provide an affordable treatment for adults with AIDS in developing countries (This Week, 1 May, p 4). But much work remains to be done. For instance,