Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date. 
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Voice of America - July 15, 2004
Cole Mallard
Bangkok
The drug Nevirapine, used to prevent mother-to-child transmission of HIV, is the subject of controversy at the 15th International AIDS Conference in Bangkok. On Sunday (7/11/04), the South African Health Minister said recent studies showed that when taken alone, Nevirapine could result in drug resistance to the AIDS virus. That is, the drug could lose its effectiveness. but activists took issue with the announcement. But a press conference was held Thursday by the researchers behind the announcement, and English to Africa's Cole Mallard covered the event.
Dr. James McIntyre is with the prenatal HIV research unit at the University of Witwatersrand in Johannesburg. He says the controversy stems from an announcement by South Africa's medical authority, which was mistaken to mean the authority would no longer allow the drug to be used.
"The Medicines Control Council has considered this and on the basis of that issued, I think, a confusing and unfortunately badly worded statement earlier in the week that suggested they would be stopping all use of single dose Nevirapine. Since then, they have clarified their response in the light of a huge public uproar in South Africa and elsewhere to say that they no longer recommend that it be used on its own because there could be better regimens around but that they won't be stopping it or banning it," he says.
At the heart of the issue is the question of resistance to Nevirapine. Dr. McIntyre says the drug is still very effective, relatively inexpensive, and convenient, especially when combined with Zidovudine, a drug that complements Nevirapine, making it more effective. But it's being proven that pregnant women who take Nevirapine alone are showing increased signs of resistance to it, making the drug, therefore, increasingly ineffective over time. That's why, the doctor says, that triple dose therapy using Nevirapine as one of the drugs, is recommended. The three drugs taken together have proven to be more reliable, more effective and easily accessible.
"What we see with combination triple therapy is that to some extent each drug cancels out the potential resistance of the others, so that if you developed resistance to one drug, one of the other two would hit that virus and so it keeps it under control," he says.
Dr. McIntyre says the issue really boils down to the individual needing treatment. He explains that if one is not very sick, Nevirapine taken in conjunction with Zidovudine is essentially all that's necessary. But he says if one's sickness is advanced then triple dose therapy is best. The compromise is the cost. Triple dose therapy is more expensive but more effective for those who need it.
"The trade off, of course, is that you can half the number of infected babies who would need treatment later, and so the cost effectiveness still needs to be looked at, as well as the absolute cost," he says. In the last analysis, Nevirapine has not been deregistered, which means it can still be obtained.
But the issue still remains complex, like the effect of aids Itself on the lives of so many people, both those who have aids, and those close to them.
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