Scientists fighting the ravages of AIDS in the Third World have shown convincingly that a short and relatively inexpensive combination of HIV drugs could reduce mother-to-baby transmission rates in Africa far more effectively than the single pill now used.
But the cost of the drug combinations could still prove prohibitive in some of the most impoverished parts of the world.
Scientists have long been searching for an alternative to the AIDS drug now widely used in the Third World, nevirapine. Nevirapine is cheap and highly effective at preventing babies from contracting the AIDS virus from their mothers. But up to two-thirds of women become resistant to the drug.
The drug combinations appear to have an extremely low rate of resistance, offering an relatively inexpensive and easy-to-take alternative for many women.
"This is very promising for low-income countries," said one of the researchers, Dr. Francois Dabis of Victor Segalen University in Bordeaux, France.
However, the drug combination would likely cost more than double the usual US$8 for a single dose of nevirapine for mother and newborn. As it is now, some countries cannot even afford nevirapine.
"It's important not to be rapidly overoptimistic," said Dr. Mary Fowler, a US Centers for Disease Control and Prevention specialist in mother-to-baby HIV transmission. "The translation from trials to programs is incredibly challenging."
The findings were presented in Boston on Thursday at the 12th Annual Retrovirus Conference, the world's chief scientific meeting on AIDS.
In impoverished lands, nevirapine is widely given in single doses to infected pregnant women in labor and then to their newborns.
In the US, the complete three-drug HIV cocktail has cut mother-to-baby transmission rates to around 2 percent. But patients in the US are given longer treatments, and drugs that are far more effective and expensive than those tested in Africa.
The African studies -- one in the Ivory Coast, one in Botswana -- reduced rates at four to six weeks after birth to about 5 percent, the lowest ever recorded in Africa. Nevirapine in single doses typically reduces that rate from around 35 percent to 12 percent.
The World Health Organization is expected to consider broadening its guidelines soon in light of research on such new regimens. Its recommendations now include single-dose nevirapine and an AZT-nevirapine regimen.
"For a minimum additional cost, we may get many benefits," said Dr. James McIntyre, an AIDS researcher in South Africa.
However, researchers cautioned that single-dose nevirapine will still be needed in many places.
About 40 million people worldwide are infected with HIV. About 65 percent live in sub-Saharan Africa.
About 3 million people died in the epidemic last year.
RSS