The San Francisco Chronicle - Saturday, July 8, 2000
David Perlman, Chronicle Science Editor

The drug, called nevirapine, has been shown to prevent transmission of the AIDS virus from pregnant women to their infants in a significant number of cases. The problem of mother-to-child transmission of the virus has been an important factor in the epidemic now raging uncontrolled throughout sub-Saharan Africa, India and many other impoverished nations.

The announcement by Boehringer Ingelheim, the German drugmaker, came on the eve of the 13th International AIDS Conference, which opens tomorrow in Durban, South Africa. At the meeting, about 10,000 people -- including physicians and AIDS researchers, as well as community leaders from countries hardest hit by the epidemic -- will share their experiences and discuss efforts to prevent and treat the disease.

Dr. Peter Piot, director of UNAIDS, the U.N. agency working to curb the devastating global epidemic, said in a statement from Durban that the drugmaker's announcement "holds out great hope for many millions of women." It is, Piot said, "a significant development in helping to make the prevention of mother-to-child transmission of HIV a reality in the developing world."

Dr. Rolf Krebs, vice-chairman of Boehringer Ingelheim, concurred. "We hope that our initiative for the prevention of mother-to-child transmission will help make an impact on the HIV/AIDS epidemic," he said. The company developed nevirapine and markets it in 75 countries under the trade name of Viramune.

The drug is given in only a single dose to pregnant women infected with HIV, the virus that causes AIDS, and in another single dose to their babies after birth. In clinical trials in Uganda involving more than 600 volunteer women, it proved twice as effective as AZT.

A new U.N. study announced yesterday found that AZT, taken in conjunction with another drug, 3TC (lamivudine), loses much of its effectiveness in protecting breast-fed babies after 18 months, according to the New York Times. The new study, which involved 1,797 people and is the largest ever performed on the transmission of AIDS from mothers to children, followed children who were born to these mothers and found that by 18 months, the initial benefit was completely lost as the infants who had been spared infection at birth later became infected through breast- feeding.

At the sixth week of the study, 6.7 percent of the babies born to mothers who took the AZT/3TC combination were infected or had died, compared with 16.4 percent in the group that received no drugs. But the infection and death rates after 18 months were 21.3 percent in the treatment group compared with 26.8 percent in the placebo group.

AZT also can cost as much as $1,000 for several months of treatment for a mother and child, while the cost of two doses of nevirapine is only $4. Yet even the modestly priced drug could bankrupt the public health budgets of many countries where the AIDS epidemic is rampant.

Estimates by UNAIDS show that at least 800,000 infants are born with HIV infection each year, virtually all in the developing world. In the absence of preventive treatment, HIV- positive women pass the virus to their offspring about one-quarter of the time. With breast-feeding, the infection rate climbs to one-third or higher, depending on the mother's health and the age at which the child is weaned.

There are still many unanswered questions about nevirapine -- including whether some mothers will be resistant to the drug and whether it can help prevent HIV transmission in the breast milk of nursing mothers who are infected with the virus. Research is continuing in an effort to answer these questions, according to Boehringer Ingelheim officials.

E-mail David Perlman at perlmand@sfgate.com.

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