iClinic - July 19, 2000
Marjolein Harvey
Speaking at a press conference in Pretoria on Wednesday, the minister said that the Intrapartum Nevirapine Trials (SAINT) results presented formally at the AIDS2000 conference in Durban has left many questions, mainly around the impact of breastfeeding on the drug's efficacy and the possibility of drug resistance.
"Relating to the challenge of reducing MTCT is the continuing evidence of significant reversal of the benefits of antiretroviral therapy where HIV positive women continue to breastfeed," said Tshabalala-Msimang.
She says this is a dilemma for government policy formulation on the topic because in most of SA rural communities breastfeeding is crucial for infant and young child survival, to prevent death from waterborne diseases.
Research results coming from the Durban AIDS conference suggest some benefits and reduced rates of transmission in HIV positive women who exclusively breastfeed, but in SA only 10% of women do so, due to the availability of breastmilk substitutes in the public health system.
"Another fact that needs to be critically analysed is the risk of resistance to nevirapine that informed the World Health Organisation's earlier reluctance to recommend the drug for widescale use in MTCT," according to the minister.
Also speaking at the briefing was director of the health departments HIV/AIDS and STDs directorate, Nono Simelela. She confirmed that there are uncertainties around the SAINT trials that need to be cleared up before the drug can be made available for the prevention of MTCT through the public health system.
"The nevirapine trials were multinational: they were held in Uganda and East Africa as well as in SA," said Simelela.
"Even in East Africa, when nevirapine-treated women continued to breastfeed their baby for up to six months, there was a significant reduction in the efficacy of nevirapine to prevent the transmission of HIV to the baby.
"In SA, most women in the SAINT trial did not breastfeed. But even with one dose of the drug, women showed a worrying resistance development and therefore it is difficult for us to provide nevirapine as a long-term strategy when the issue of resistance is not clarified.
"In Kenya, keeping in mind that breastfeeding generally reduces energy and resistance in the mother, a significant number of breastfeeding women eventually succumbed to disease, despite having been given nevirapine," said Simelela.
The Minister of Health shared her concern that the media and the SA public "are pushing government in a corner, forcing us to provide nevirapine, when even the scientists themselves still have unanswered questions about the drug".
She hopes that a government meeting with scientists on August 12-13 will bring clarity to these questions. She was not able to provide more clarity on when nevirapine will be issued to HIV positive pregnant women in SA.
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