South Africa, with the highest rate of Aids infected babies in the world, is the only country — of 72 using nevirapine — to consider delisting the drug which is used to prevent HIV in infants.
”We need to increase access,” Professor James McIntyre, head of the Perinatal HIV Research Unit at Chris Hani Baragwanath hospital in Soweto, told a packed special plenary at the Durban Aids Conference on Wednesday.
”Around 2 200 infants per day are estimated to be infected as a result of mother-to-child transmission in South Africa. Yet only three percent of HIV infected women in Africa access these programmes.”
South Africa is enjoying marginally greater success in its application of the drug than elsewhere in the world. He noted that if more mothers accessed ante-natal care earlier, South Africa’s capacity to further slow the rate of HIV-transmission with nevirapine could be improved.
More than 80 000 women and babies in South Africa have received nevirapine over the past two years.
McIntyre was speaking on a platform with Medicines Control Council (MCC) head, Precious Matsoso, who is leading the council in its controversial bid to delist nevirapine. Also on the stage were Kathy Wilford of the Washington-based Elizabeth Glaser Paediatric Foundation, and Prudence Mabele, an HIV-positive mother who lost her baby because treatment to prevent HIV in her infant was not available.
McIntyre, who co-authored the World Health Organisation’s guidelines on the prevention of mother to child treatment (PMTCT), said that two major drug trials of nevirapine in South Africa had shown ”no significant adverse events in mother or baby”.
This had been shown in a range of other studies. The MCC has indicated in public comments that it is not concerned about the safety or toxicity of the drug but that it wants further evidence of the drug’s efficacy.
However, according to McIntyre, nevirapine appears to be showing greater efficacy in South Africa than elsewhere.
At Johannesburg’s Coronation Hospital, only 8,9% of babies born to HIV-positive mothers contracted HIV after nevirapine was administered. This figure was 11,9% at both Chris Hani Baragwanath and King Edward hospital in Durban.
At Marianhill hospital in KwaZulu-Natal the efficacy was even better, with only six percent of such babies becoming HIV positive after receiving nevirapine. In Lusaka, Zambia the figures were 11,24% and in Cameroon, 10,6%.
McIntrye said PMTCT implementation programmes using nevirapine had been established in more than 20 countries and ”none have reported safety or toxicity programmes”.
If nevirapine is not used for PMTCT, AZT can be used as it is the only drug presently registered for use to stop HIV transmission to babies. However, the drug is costlier and needs to be used for a longer period of time. Nevirapine is given as a single dose to the mother during labour and a teaspoonful to the baby three days after birth.
McIntyre said too that there was no evidence that AZT alone was more effective than nevirapine. It only became more efficient than nevirapine when it was combined with other anti-retrovirals such as AZT coupled with 3TC (Combovir). – Sapa