San Francisco Chronicle; Tuesday, June 30, 1998
David Perlman, Chronicle Science Editor

The initiative was among the highlights yesterday during the 12th World AIDS Congress, the largest conference on AIDS to be held since the epidemic began.

The U.N. program is aimed at narrowing the gap between the developed world, where infection rates and deaths have been slowed through the use of expensive combination-drug regimens, and poorer countries where AIDS and HIV, the virus that causes the disease, remain largely unchecked.

Support for the effort has been pledged by the World Bank and the European Community. A few drug companies are promising to slash prices for the anti-viral drug AZT and other medicines.

Dr. Peter Piot, director of UNAIDS, the United Nations' semi-independent AIDS-battling agency, disclosed that health workers in 11 Third World countries are about to offer confidential AIDS testing to 30,000 pregnant women, together with speeded access to AZT for every woman infected with the deadly virus.

Piot said at least 600,000 HIV-infected infants were born to infected mothers last year. Ninety percent of them were in Africa, and most of the mothers were unaware that they carried the virus.

Clinical trials have shown since 1994 that AZT -- administered to women during their last four weeks of pregnancy -- can cut newborn infection rates in half.

More recent tests of varying ways to apply the drug have achieved even more dramatic results -- saving as many as 97 percent of at-risk babies from becoming infected.

UNAIDS supports trial programs of all kinds. Efforts focus mainly on Third World countries, where 95 percent of the epidemic's victims have been stricken, and where poverty, medical resources, clean water, decent nutrition and even stable governments are lacking.

Dr. Bernard Kouchner, France's secretary of state for health, has beaten the drums around the world to scare up enough resources to cope with the problem.

Piot and Kouchner's economic experts have calculated that it will cost about $50 to test and counsel each woman for the presence of HIV, another $50 to provide her with substitutes for breast-feeding, which can contaminate babies with the virus, and perhaps $20 for the AZT dosages each infected woman will need.

That means the first phase of the effort in the first 11 Third World countries would cost at least $3.6 million. As the effort spreads to protect hundreds of thousands of newborns every year in countless more countries, the cost could skyrocket from millions into the billions of dollars.

So far, Kouchner said, his quest for support has been successful: "When I tell the president of the World Bank," he said, "that for $50 he can save a child's life, he can hardly refuse, and so far he has not."

AZT in pill form cannot do the job alone, and HIV-infected mothers who breast-feed their babies can transmit the virus in the milk. Another risk factor is breast lesions that afflict many young mothers in poor countries. In high-risk parts of the world, at least 30 percent of pregnant women receive no prenatal care. Forty percent must undergo unsafe deliveries and get little or no follow-up care after delivering, according to Dr. Awa-Marie Coll- Seck, an infectious-disease specialist from Senegal who is UNAID's director of policy, strategy and research.

Ways must be found to block such routes of infection, she said, and much of that job will fall to UNICEF, the U.N. children's welfare organization.

"All our efforts at providing safe water and other protections for children have been undermined, undone, by the AIDS epidemic," said Dr. David Alnwick, UNICEF's health chief. "But we are now committed to supporting every possible practical action that will prevent the transmission of HIV from mother to their infants."

Alnwick's agency will help provide access to voluntary, confidential counseling and AIDS testing for pregnant women, he said, and will help develop alternatives to breast-feeding.

That pledge marks a significant policy reversal for UNICEF. The agency has always strongly encouraged mothers throughout the world to breast-feed their babies rather than use commercial infant formulas, citing risks from polluted water and nutritional problems.

Breast milk, however, can be heat-treated to minimize the infection risk, Alnwick suggested. Or "milk banks" could be created under UNICEF auspices, using supplies from uninfected volunteers backed up by thoroughly screened wet nurses, he said.

LEGACY OF ORPHANS

Amid the encouraging prospects for saving infant lives, however, came a note of warning from a young woman who identified herself only as a Paris member of ACT UP, the militant organization that has played an important, if often provocative, role in pushing for faster scientific progress in the AIDS fight.

"You may save the babies," she said, "but what about the mothers after you've protected their newborns with your `short courses' of AZT? You are going to create an orphan factory."

Kouchner shrugged at that challenge, then replied: "This epidemic has gotten ahead of us completely. We cannot have a perfect strategy against it. But we must move as swiftly as we can wherever we can, and of course that means we must move into the battle of providing access to real and continuing care for the mothers.

"But let us also start now with what we can realistically do, and save the babies now that we can do it."

NEW SURGERY TECHNIQUES

Other successful efforts in HIV- prevention in newborns through surgical delivery were reported during the Geneva conference by researchers from several advanced countries.

In one trial, Dr. Laurent Mandelbrot of France's National Center for Health and Medical Research and his colleagues were able to cut the infection rate among newborns to less than 1 percent using a combination of drugs and early delivery by cesarean section.

AZT was administered to more than 900 HIV-infected pregnant women during their last four weeks of pregnancy. The babies were then delivered by C-section before their virus-infected membranes broke and labor began. AZT was also given to the babies for several weeks after birth.

In one series of 133 cesarean deliveries, for example, AZT protection plus the elective surgery resulted in only a single baby born with HIV, Mandelbrot said. Full results will be published this week in the Journal of the American Medical Association

Mandelbrot conceded that although the procedure could be recommended in every country where access to safe operations is widespread, most poor nations can barely afford skilled surgery for their sickest people -- let alone to protect babies from AIDS.

980630
SC980608

Always watch for outdated information. This article first appeared in 1998. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1998. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .