United Press International - Wednesday, November 11, 1998

For at least four years, scientists have known that giving the antiviral drug to mothers before and during labor and to the newborn infant can reduce transmission of the AIDS-causing human immunodeficiency virus (HIV) by about 70 percent.

In this study the investigators found that giving the drug to babies only after they were born -- and not the mother before and during childbirth -- also helped ward off the fatal disease.

This may help in cases where women do not have access to prenatal care, the scientists say. The finding may also be important for women in poor countries, since the abbreviated therapy is far less expensive, about one tenth the price of the full treatment.

The new research, from the AIDS Institute at the New York State Department of Health in Albany, is based on an analysis of sensitive genetic tests given to nearly 1,000 babies born to infected mothers in New York. It appears in Thursday's issue of The New England Journal of Medicine.

The investigators say that while abbreviated regimens were not recommended, they were used in cases where women did not come in for prenatal care or chose not to take the drugs earlier.

In the study, the scientists found that even if the drug is given to the babies after they are born, it will significantly reduce the rate of infection.

Without any AZT, about 26 percent of infants caught AIDS from their infected mothers, the scientists found.

But when AZT was given during delivery and in the first two days of life, the rate of transmission was about 10 percent.

In cases where the baby was given the drug in the first two days, only about one out of 10 infants, roughly 9.3 percent, became infected.

Delaying treatment to day three or later nearly doubled the rate of infection, to about one in five infants or 18.4 percent, the scientists say.

With the full three-part therapy, including treating the mother well before delivery, the rate of transmission was about 6.1 percent.

In an editorial accompanying the study, Kenneth McIntosh of the Children's Hospital in Boston says that the study contains some reassuring and confirmatory information, as well as some surprising and provocative new observations.

He says the biggest surprise of the study was that giving AZT to babies after they were exposed to the virus still appeared to help.

But, he says that these findings need to be confirmed by other groups, and, for ethical reasons, conducting a trial would be impossible in the United States and questionable in less affluent countries.

He adds, however, if treatment of the baby alone is confirmed to prevent transmission from the mother, such information could have important public health implications in parts of the world where the high cost of antiretroviral drugs remains an obstacle to their use.

Dr. Susan Cu-Uvin, an assistant professor of obstetrics and gynecology at Brown University, Providence, R.I., says she believes the study's findings are very important.

Cu-Uvin, who was not involved with the research, says the information will be particularly valuable for women who get no prenatal care, and show up at the doctor's office while they are in labor.

She says, "If we can save these babies, even if it is not perfect, I think there is room for this treatment."

Cu-Uvin is scheduled to present data from her own research on the use of extreme therapies, those that may involve three to seven anti-AIDS drugs, at the annual meeting of the Infectious Diseases Society of America, in Denver later this week.
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