Reduction in Perinatal Transmission of HIV (2)
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I think the contribution from Chris Green about the results of the HIV
vertical transmission is most useful and I find that I agree with it in
general. To summarise, the trial in Thailand has shown us that it is
possible to reduce transmission significantly. Albeit that a large num-
ber of women need to be treated for a limited benefit. The trial does
not address the breast feeding issue either.
So what are the implications of the trial. It seems to me that for the
individual woman who knows she is HIV positive, has been fully coun-
selled and has the resources to purchase the AZT AND is willing and
able to forgo breast feeding this treatment should be offered to her.
But I would suggest that this should be done by the private sector or
the NGO sector in a country. I think that governments have higher pri-
orities such as adequately treating STD's, tuberculosis, malaria etc.
Also, we know from the Mwanza trial that treating STD's is a more cost
effective way to prevent HIV transmission.
I agree that mass screening of pregnant women in most countries would
be inappropriate without the resources both financial and human to meet
the need generated.
So I think this dialogue on the issue has been helpful to clarify the
issues. But as Chris says progress will come in small steps not giant
leaps. For a few rich women who are HIV positive and pregnant this is
such an advance. For the vast majority of women they are still likely
to die waiting.
The one policy implication of these observations is the need to make
AZT available at low prices through NGO or private channels in those
countries where it will be used. This will be complicated as drug com-
panies prefer to make cut price drugs available through governmental
channels so that they can avoid parallel markets. A new challenge! Of
interest in that WHO have now added AZT (zidovudine) to their Model Es-
sential Drug list for this indication alone in their latest revision.
Richard Laing
Dept. of International Health,
Boston University School of Public Health
mailto:richardl@bu.edu
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