E-DRUG: Nevirapine, MTCT and Africa
-----------------------------------
[Nevirapine in MTCT is simple and affordable, and reasonable effective.
Recent studies have shown an increased risk of resistance being developed.
A difficult debate is now starting what to do. All HIV+ pregnant women on
HAART? WB]
Experts express doubts on anti-Aids birth drug
Rory Carroll in Johannesburg
Wednesday March 17, 2004
The Guardian
Aids experts warned yesterday that Africa should stop using a drug which
has been hailed as one of the continent's best tools in fighting the HIV
pandemic. They said the drug, Nevirapine, which reduces the number of
mothers transmitting the HIV virus to new-born babies, risks doing more
harm than good.
Single doses of Nevirapine should make way for a much costlier but less
risky alternative, said Sant'Egidio, an Italian non-governmental
organisation. The single dose might be cheap and easy to administer, but
Nevirapine left too many babies born with HIV, did not extend the lives of
mothers, and was responsible for growing resistance to other anti-Aids
drugs, it was claimed.
Doubts about Africa's most widely used method of preventing mother-to-child
transmission will dismay activists, who valued it as one of the few drugs
simple enough to administer through ramshackle health systems.
Nevirapine, also called Viramune, slows the reproduction of HIV by
interfering with a key viral enzyme. Its use in combination with other
antiretroviral drugs such as AZT and 3TC to treat the virus is not
controversial.
In poor countries, it is mostly used alone as a single oral dose to a
mother during labour and a single oral dose to the infant within 72 hours
after birth, a simple intervention which halves the number of newborns who
contract HIV through infected mothers. The manufacturer, Boehringer
Ingelheim, gives it free to state hospitals in developing countries.
At a press conference in Johannesburg to announce its plan to set up
treatment in six African countries, Sant'Egidio yesterday made a blunt case
against Nevirapine: "It has no future in Africa."
Its spokesman, Mario Marazziti, said the method left too many infants with
the virus and doomed them to being orphans since the single dose did not
extend their mothers' lives.
A third concern was that the drug would not benefit the babies of the
estimated 15% of mothers who had a HIV strain resistant to Nevirapine.
The more mothers were given single doses of the drug the more a
Nevirapine-resistant strain of HIV could spread, undermining the
combination therapy. Instead, said Mr Marazziti, pregnant mothers should be
given triple therapy in which Nevirapine was one part of a drug cocktail,
months before giving birth.
This reduced the risk of drug resistance, and according to Sant'Egidio's
projects in Mozambique, left 97% of infants born without the virus.
Paul Roux, a paediatrician at Groote Schuur hospital in Cape Town, said he
and colleagues were expecting single-dose Nevirapine to be phased out
because of the danger of drug resistance.
But James McIntyre, director of peri-natal HIV research unit at
Johannesburg's University of Witwatersrand, said calls to drop Nevirapine
were well-meaning but naive.
South Africa alone had 250,000 pregnant women with HIV each year and it
could not afford the infrastructure to put all of them on triple therapy.
Three months' worth of drugs for one expectant mother would cost around
Aids experts warned yesterday that Africa should stop using a drug which
has been hailed as one of the continent's best tools in fighting the HIV
pandemic. They said the drug, Nevirapine, which reduces the number of
mothers transmitting the HIV virus to new-born babies, risks doing more
harm than good.
--
To send a message to E-Drug, write to: e-drug@healthnet.org
To subscribe or unsubscribe, write to: majordomo@healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug