United Press International - Thursday, 13 July 2000
Ed Susman, UPI Science News

"This is tremendous news," said Dr. Lynne Mofenson, of the Pediatric, Adolescent and Maternal AIDS Branch, National Institutes of Health, Rockville, Md.

Added Kim Nichols of the African Services Committee, Inc., New York, "These studies are so promising that we need to influence our governments to implement these programs."

In the Ugandan study, doctors compared the use of a short course of the antiretroviral drug nevirapine to another drug AZT in treating pregnant women infected with HIV, the virus that causes AIDS. In previous studies AZT had been shown to prevent transmission of the virus from the mother to the infant during pregnancy, but AZT required a longer course of treatment and was more costly than nevirapine.

Dr. Maxi Owor, a pediatrician at Mulago Hospital in Kampala said that the nevirapine dose was just one dose to the mother during labor and one dose to the child after delivery. When compared to the standard AZT treatment, women receiving nevirapine were able to reduce the risk of transmitting the virus to their children by more than 30 percent. The latest findings stem from the continued follow-up of breast-feeding mothers and their babies enrolled in a clinical trial at the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. Last year, results from that trial showed that a short regimen of nevirapine given to both mother and child significantly reduced HIV transmission. Thursday's report demonstrated this reduction in mother-to-infant transmission of HIV was sustained even though the infants were breast fed.

In other trials involving treatment of pregnant women with antiretroviral drugs, the benefit to the children has been blunted because breast-feeding techniques and length of time of breast feeding can also infect the child. In many developing countries, women -- even those with HIV-infection -- have no choice but to breast feed because uncontaminated water and food products are not available for the infants.

More than 600 women were enrolled in the trial conducted at the teaching hospital of Makerere University in Kampala. The six-week data showed that mothers and infants who received nevirapine had a 42 percent lower risk of HIV transmission when compared with those receiving AZT.

New data on those same infants 12 months later shows that with nevirapine the risk of HIV transmission was reduced by 39 percent, and preliminary results indicate a reduction of 42 percent after 18 months.

Dr. Helene Gayle, director of the National Center for HIV, STD (sexually transmitted disease) and TB (tuberculosis) Prevention at the Centers for Disease Control and Prevention (CDC), Atlanta, said the evidence from the Uganda trial and others conducted in Thailand and South Africa, confirmed that the antiretrovirals -- both nevirapine and AZT -- substantially reduce the risk of transmission of disease from mother to infant. "The data is unequivocal on that," she said. "The data are clear that it makes sense to use these drugs to prevent transmission." However, Gayle said that preventing transmission of the virus to the child is not the end of a very complex story. "We still have an infected mother and we need to provide therapy for her; we need to have screening and testing programs in place so we can identify the women earlier," she said.

Mofenson said that with universal implementation of the treatment of women in pregnancy around the world, "we can save the lives of 240,000 babies a year."
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