Newsday - Thursday, February 3, 2000
Laurie Garrett, Staff Correspondent

At this week's seventh Conference on Retroviruses, scientists presented ideas for new drugs and possible vaccines-all of them enormously expensive, even by American standards. And although most patients gain undeniable benefits from current combination drug treatments, studies at the conference show most still die eventually of AIDS or a host of new health problems.

"It's interesting to ask yourself what a prevention or treatment program would look like if the HIV prevalence in Atlanta, for example, were 23 to 24 percent," the Centers for Disease Control and Prevention's Dr. Kevin De Cock said in comments to the scientists.

That is exactly what African health planners are up against. A striking study presented by Dr. Anne Bouv of the Institute of Tropical Medicine in Antwerp, Belgium, found that in Kisumu, Kenya, 23 percent of girls aged 15 to 19 are infected with HIV. In Kwazulu Natal, South Africa, 28 percent of girls in that age group are infected.

South African Ministry of Health official Dr. Ian Roberts said in an interview that up to 40 percent of all women of reproductive age are infected with HIV in rural parts of Kwazulu Natal.

Because South Africa is the most industrialized and influential nation on the continent, world attention has zeroed in on its decisions. The government of President Thabo Mbeki has in recent months decided that the sorts of drug cocktails used to treat HIV patients in the United States and Europe will not be provided to South African patients; the country can't afford them, he said. More surprising to outside observers was Mbeki's decision to deny the use of AZT, which is very cheap, to block the transmission of the virus from mother to baby even though the drug was offered at a dramatically discounted rate. And another, even cheaper, drug that can be taken in a single dose during pregnancy, nevirapine, has not gained the Mbeki government's support.

"Something is happening in South Africa where the government is trying to find a reason not to move ahead," Dr. Arthur Ammann, president of Global Strategies for AIDS, a nonprofit humanitarian organization said in an interview. "Yes, there are problems. But the benefit we're deriving [from these drugs] is so great, I just don't understand what is happening," when governments reject them.

In the United States, the Santa Monica, Calif.-based Elizabeth Glaser Pediatric AIDS Foundation, which pioneered some of the maternal AZT work, has made persuading South Africa and other nations to use AZT or nevirapine its new mission.

But two babies have died recently in the United States as a result of AZT-induced destruction of their mitochondria, vital components of all human cells. And yesterday Dr. Susan Eshleman of Johns Hopkins University in Baltimore described the disturbing results of experiments using nevirapine in Uganda. There, women took a single dose of the drug during labor, blocking about half of all transmission of HIV to their babies. That looked good.

But close genetic analysis of the viruses found in 15 of the mothers and their babies revealed that after just a single dose to the drug a fifth of the mothers developed nevirapine-resistant, mutant forms of HIV. One mutant strain was passed to a newborn.

Ammann said such drug resistance shouldn't dampen enthusiasm for the use of nevirapine-unless future studies reveal that the mutant viruses can be transmitted from mother to child in breast milk. But Roberts said such findings are precisely why South Africa is hesitant to allow the American-made drug in its country: "We want to be sure what we do is safe."

U.S. scientists may not be able to resolve such debates, ultimately, De Cock of the CDC said. Nobody is keeping track of the thousands of women and babies who have received AZT or nevirapine to see what-if any-side effects might turn up in the HIV-negative among them years after taking the drugs.

Always watch for outdated information. This article first appeared in 2000. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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