The Associated Press - July 14, 1999
Lauran Neergaard

The drug nevirapine already is widely sold around the world to treat AIDS. But the new study found it is 47 percent more effective than the therapy now recommended in developing countries for preventing mother-to-baby transmission of the AIDS virus.

The discovery, announced Wednesday by U.S. scientists, could finally boost AIDS prevention among the world's poorest countries because for the first time the nations most afflicted by the AIDS epidemic could afford to buy babies some protection.

"You're talking about the possibility of preventing infection in up to 1,000 babies per day for a cost that is really very minor," said Dr. Anthony Fauci of the U.S. National Institutes of Health, which funded the research. "Now all of a sudden it falls, at least in some countries, within the realm of affordability."

"This research provides real hope that we may be able to protect many of Africa's next generation from the ravages of AIDS," said Uganda's health minister, Crispus Kiyonga, in a statement.

One of the greatest successes in the fight against AIDS is using the drug AZT to lower pregnant women's chances of spreading the deadly virus to their newborns. In the United States and other wealthy countries, infected mothers typically receive five months of AZT, a therapy that cuts in half their babies' risk of infection.

But that treatment can cost more than $1,000, far beyond what developing countries can afford.

Last year, scientists discovered that giving far fewer AZT doses, starting during labor, could protect newborns, although not as effectively as the treatment Americans get. But even that "short-course AZT therapy" was too expensive for many countries.

Nevirapine is a cheaper AIDS drug. Although it works against the same viral target as AZT, it stays in the body for a longer time, crosses the placenta and even gets into breast milk.

U.S. scientists, working with doctors in Uganda, studied 618 mothers. Half got short-course AZT. The other half got a single dose of nevirapine during labor, and their babies got a single dose within three days of birth.

The scientists hoped nevirapine would prove as good as AZT - but to their surprise, it worked far better. Just 13.1 percent of nevirapine- treated infants became infected with HIV, vs. 25.1 percent of AZT- treated babies.

The United Nations estimates that 1,800 HIV-infected babies are born daily in developing countries. In parts of sub-Saharan Africa, the region hardest-hit by AIDS, up to 30 percent of pregnant women are infected.

Widespread use of nevirapine could prevent between 300,000 and 400,000 babies a year from contracting HIV at birth, the NIH said.

The new study has implications for American women, too: If a woman goes into labor without having had prenatal AZT treatment, doctors could consider giving her nevirapine, Fauci said.

In addition, a study under way of U.S. and European women will attempt to determine whether adding nevirapine to the longer and more expensive AZT therapy that they now take also would work better.

Nevirapine, sold in the United States under the brand name Viramune, appeared safe for infants. But scientists will follow the babies until they're 18 months old, both to look for possible long-term side effects - and to see whether nevirapine also could protect against HIV in breast milk. Babies born healthy still can become infected through breast-feeding, something no drug so far has prevented. But early data are "highly suggestive" that nevirapine might prove beneficial in breast milk, Fauci said.
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