E-drug: Reduction in Perinatal Transmission of HIV (cont'd)
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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 summarize, the trial in Thailand has shown us that it is
possible to reduce transmission significantly. Albeit that a large
number 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
counselled 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 priorities such as adequately treating STD's, tuberculosis,
malaria etc. Also, we know from the Mwanza trial that treating is 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
companies prefer to make cut price drugs available through
governmental channels so that they can avoid parallel markets. A new
challenge! Of interest is that WHO have now added AZT (zidovudine) to
their Model Essential Drug list for this indication alone in their latest
revision.
Richard Laing
Boston University
e-mail: richardl@bu.edu
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