E-DRUG: good and bad news from Durban AIDS 2000
-----------------------------------------------
[account from Andy Gray in the Durban AIDS conference; WB]
Hi all
Some eagerly awaited results are emerging from the AIDS
Conference
Fot those really keen to experience the conference "first-hand", try
the webcast (scientific presentations, complete with audio and
video of speakers and slide presentations) at:
Also worth a visit is AEGiS, reportedly the largest HIV/AIDS site in
the world, which is providing news from the AIDS conference in
Durban via its news by e-mail service at:
http://www.aegis.org/todaysnews/list.asp
However, local [South African] print media is also providing saturation coverage.
First the good news (from SAPA)
[Several clinical trials on nevirapine and AZT for MTCT presented here in Durban
that the long term safety and efficacy of both drugs is good. However, it is clear that
breastfeeding partly undoes this effect by increasing the HIV infection rate with 14% again.
Exclusive breastfeeding for up to 3-6 months is recommended if the mother does not
have access to safe water and infant formula. WB]
"Government pleased with research results on Nevirapine.
Gauteng Health MEC Gwen Ramokgopa says the government was
confident the antiretroviral drug Nevirapine could be used as an
alternative to AZT in preventing the transmission of HIV from mother
to baby. Results of Nevirapine trials involving 1300 pregnant women
over a ten-month period showed the drug significantly decreased
the chances of babies becoming HIV infected during birth. The
department of health said it was encouraged by the results and it
would meet with the researchers soon after the conference to
discuss them in more detail. Nevirapine is cheaper than AZT and
can be administered and monitored very easily without the need for
complicated infrastructure. Ramokgopa said the government would
critically review the research data as well as its implications for
public policy. She said the government did not doubt the data,
which emerged from the trials, but there were other issues that
needed examination. Nevirapine offers a way out to the
government, which has been under fire for refusing to treat HIV-
positive pregnant women with the more established anti-retroviral
AZT (Azidothymidine). The government is concerned about AZT's
toxicity and its high price.
However, Zweli Mkhize, the KwaZulu
Natal minister of health, said the public health sector would require
an additional R13 billion by 2010 to meet the costs incurred in
caring for 80 percent of South Africa's HIV-positive population. In
addition, the private sector would need a further R3 billion to
finance its share of managing the epidemic. Meanwhile, Mkhize
said wide spread antiretroviral treatment was not an option as it
would cost about R2 billion to treat only 120 000 of the 4,2 million
HIV-positive South Africans. [Dr Mkhize now refers to the cost of "triple
treatment" with antiretrovirals. Nevirapine has been offered by Boehringer
Ingelheim for free for 5 years. WB] This was more than the R150 million
budgeted for AIDS prevention strategies. The government's focus
therefore remained largely on prevention strategies, which had seen
the number of free condoms distributed monthly in KwaZulu Natal
increase from 2,8 million in 1999 to 3,5 million in 2000. However,
with considerable doubt being expressed about how much impact
prevention strategies were having on the ground, other policies
included improving the management of sexually transmitted
diseases, voluntary AIDS testing and counselling, home-based
care and an AIDS hospice model."
However, when pressed for comment, the Director-General of the
National Department of Health would not give a timeframe within which
the government would respond.
Then the bad news - perhaps the greatest disappointment has
been the news that the microbicide Nonoxynol-9 is probably more
harmful that useful (this one from Business Day):
"Microbicide may increase risk of HIV
Women at a high risk of contracting HIV have been warned not to
use a well-known microbicide that has been on the market for 50
years and used initially as a spermicide. This follows preliminary
results from research done among prostitutes in SA and presented
at the AIDS Conference. Microbicides are substances used
vaginally or rectally to fight various sexually transmitted organisms
and which hold great hope for fighting HIV. The present setback,
however, which refers to a substance known as nonoxynol-9 (N-9),
raises problems for the Medicines Control Council, the health
department and importers and sellers of condoms containing the
substance, as well as various formulations of the microbicide that
are sold commercially. Test results in large clinical trials
conducted in Durban and Johannesburg among prostitutes showed
that those using N-9 developed lesions. Although in laboratory
tests N-9 indicated it could kill the HI virus, when tested among
women it appears to have spread the infection. The group using N-9
had a significantly higher rate of infection than the group using a
placebo. However, Medicines Control Council chairman Helen Rees
cautioned that the results were not conclusive and more work
needed to be done on the issue. Several other microbicides are
due for clinical trials soon, which may yield better results, she
said. Rees said N-9 was selected for trials because of the promise
it held out in laboratory conditions. She said because it was
already well known on the market, it would also have made it
easier for women who needed it to get hold of it. It is this fact,
however, that will now cause problems for the drug regulatory
authority and the health department that are faced with the
possibility that the product, widely available and widely used, may
actually spread HIV infections."
So - very much a case of one step forward, one step back. The
bets news though is that "access" is the buzzword of the
conference.
regards
Andy