Healthy Skepticism Library item: 268

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Publication type: news

Carroll R.
Experts express doubts on anti-Aids birth drug
The Guardian 2004 Mar 17

Full text:

Aids experts warned yesterday that Africa should stop using a drug which has been hailed as one of the continent’s best tools in fighting the HIV pandemic. They said the drug, Nevirapine, which reduces the number of mothers transmitting the HIV virus to new-born babies, risks doing more harm than good.

Single doses of Nevirapine should make way for a much costlier but less risky alternative, said Sant’Egidio, an Italian non-governmental organisation. The single dose might be cheap and easy to administer, but Nevirapine left too many babies born with HIV, did not extend the lives of mothers, and was responsible for growing resistance to other anti-Aids drugs, it was claimed.

Doubts about Africa’s most widely used method of preventing mother-to-child transmission will dismay activists, who valued it as one of the few drugs simple enough to administer through ramshackle health systems. Nevirapine, also called Viramune, slows the reproduction of HIV by interfering with a key viral enzyme. Its use in combination with other antiretroviral drugs such as AZT and 3TC to treat the virus is not controversial.

In poor countries, it is mostly used alone as a single oral dose to a mother during labour and a single oral dose to the infant within 72 hours after birth, a simple intervention which halves the number of newborns who contract HIV through infected mothers. The manufacturer, Boehringer Ingelheim, gives it free to state hospitals in developing countries. At a press conference in Johannesburg to announce its plan to set up treatment in six African countries, Sant’Egidio yesterday made a blunt case against Nevirapine: “It has no future in Africa.”

Its spokesman, Mario Marazziti, said the method left too many infants with the virus and doomed them to being orphans since the single dose did not extend their mothers’ lives.

A third concern was that the drug would not benefit the babies of the estimated 15% of mothers who had a HIV strain resistant to Nevirapine.

The more mothers were given single doses of the drug the more a Nevirapine-resistant strain of HIV could spread, undermining the combination therapy. Instead, said Mr Marazziti, pregnant mothers should be given triple therapy in which Nevirapine was one part of a drug cocktail, months before giving birth.

This reduced the risk of drug resistance, and according to Sant’Egidio’s projects in Mozambique, left 97% of infants born without the virus.

Paul Roux, a paediatrician at Groote Schuur hospital in Cape Town, said he and colleagues were expecting single-dose Nevirapine to be phased out because of the danger of drug resistance.

But James McIntyre, director of peri-natal HIV research unit at Johannesburg’s University of Witwatersrand, said calls to drop Nevirapine were well-meaning but naive.

South Africa alone had 250,000 pregnant women with HIV each year and it could not afford the infrastructure to put all of them on triple therapy.

Three months’ worth of drugs for one expectant mother would cost around Aids experts warned yesterday that Africa should stop using a drug which has been hailed as one of the continent’s best tools in fighting the HIV pandemic. They said the drug, Nevirapine, which reduces the number of mothers transmitting the HIV virus to new-born babies, risks doing more harm than good.