Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
Bangkok Post - September 22, 2008
Apiradee Treerutkuarkul
Manoon Leechanwengwong, president of the Thai Aids Society, said the anti-retroviral treatment programme practised across the country could increase the chances of pregnant HIV-infected women becoming drug resistant.
The mother-to-child transmission programme focused on preventing children from getting Aids. It did not consider what could happen to HIV-infected mothers, he said.
Under the national Aids prevention programme, zidovudine (AZT) is provided to pregnant HIV-infected women from the 34th week of pregnancy until the onset of labour.
Nevirapine is also given every three hours until delivery.
The intervention could reduce Aids transmissions from mother to child to 4%.
Dr Manoon said that guideline was recommended by the World Health Organisation for countries with few resources. Many poor nations in sub-Saharan Africa could adopt the guideline to tackle Aids, which still remains at high levels.
However, an HIV-infected mother with a CD4 cell count (a measure of the amount of HIV in the blood) in the normal 500-1500 range could develop resistance to nevirapine.
Some symptoms could be severe, life-threatening, or even fatal.
Unlike the WHO-recommended guideline, US interventions to reduce perinatal HIV transmission recommend the use of combinative drugs during the 14th-34th weeks of pregnancy.
In addition, AZT and lamivudine are also given 3-7 days after birth, to reduce nevirapine resistance.
The president of the Thai Aids Society said studies showed the interventions recommended by the US National Institute of Health could reduce HIV transmission from mother to child to 1%. The government should revise the national treatment guideline to bring it more into line with the US one, he said.
Thailand has enough money to improve its prevention programme after announcing a compulsory licensing policy to bypass the patent on Aids drugs efavirenz and lopinavir/ritonavir, he said.
About 7000-8,000 new cases of pregnant women infected with HIV/Aids are reported each year. Without better measures to reduce the risk of mother-to-child transmission, the number of newborn babies infected with the virus could rise to 1,800 to 2,000 a year, according to the Public Health Ministry.
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