IRIN Focus on mother-to-child-transmission

Fresh hope is emerging in the battle to stem mother-to-child HIV transmission with the announcement by the US Centre for Disease Control and Prevention (CDC) that short courses of the anti-AIDS drug AZT can significantly cut infection rates. The CDC said that in studies conducted in the United States, mother-to-child HIV transmission was reduced by some 50 percent. With an HIV infection rate of 30 percent among pregnant women in sub-Saharan Africa, and where 25-35 percent of infants are being born HIV positive, the AZT results could prove an important weapon in the fight to slow the spread of HIV/AIDS on the continent. African realities However, the relative success of the US trials may not directly translate into similar benefits for Africa. The CDC said that in AZT programmes conducted in Africa, prenatal prevention efforts were effective. But, transmission through breastfeeding combined with high drop out rates in prenatal prevention programmes, had “remained powerful obstacles to the significant reduction on prenatal transmission of HIV, even when anti-HIV drugs were available”. The CDC cited the case of the West African nation of Cote d’Ivoire, where there were still significant barriers to preventing mother-to-child-transmissions. It said that despite the availability of short courses of AZT for pregnant women, combined with early HIV testing, counselling and free milk formula, many women were unable to abstain from breast-feeding their babies because of a lack of family and community support. “Breast feeding transmits HIV, but remains a difficult practice to replace, particularly with the lack of viable alternatives,” CDC researcher Stefan Wiktor said. The US centre said that in two studies conducted in Abidjan, Cote d’Ivoire and Bobo-Dioulasso in Burkina Faso, researchers found that short courses of AZT had significantly reduced the overall rate of prenatal HIV transmissions, despite having no impact on postnatal transmissions. “Many of the infants born uninfected became infected by the age of two through breastfeeding,” the CDC noted. It said that at six weeks, 14 percent of infants whose HIV positive mothers took AZT during their pregnancy were infected, compared with 23 percent of those whose mothers did not take AZT. At two years, 22 percent of children whose mothers took AZT were HIV positive, compared with 30 percent of mothers who did not. Additional problems “While the results show that a short-course of AZT given to women alone does reduce prenatal HIV transmission, there is also a need to develop additional interventions to prevent mother-to-child transmissions,” the CDC warned. It said that a survey conducted among 120 households in Abidjan found that water storage practices were important when considering ways to prevent transmission. The survey showed that where water was poorly stored, bacterial contamination often resulted in high rates of diarrhoeal diseases in infants. This frequently meant that women reverted to breast-feeding in nursing their children. The nevarapine issue Meanwhile, the international pharmaceutical company Boehringer Ingelheim said on Wednesday its research had demonstrated that its drug nevarapine was also effective in blocking mother-to-child-transmission of HIV. Nevarapine is cheaper than AZT and easier to administer, as it only requires one dose. “These data demonstrate that nevirapine can be a viable option in the prevention of mother-to-child-transmission of HIV in the developing world. Intervention around the time of labour and delivery reduces HIV transmission significantly,” Dr Daya Moodley from the University of Natal in Durban said. “Considering that more than 60,000 South African infants are infected with HIV every year, these regimes can potentially save thousands of babies annually from HIV infection,” said Dr Hoosen Coovadia, chair of the Durban AIDS conference. The pharmaceutical company said that the drug was tested on mother and infant pairs, and that there were “no serious treatment-related adverse effects through six weeks”. Boehringer Ingelheim said on Tuesday that it would make an offer to the South African government to make nevarapine available to millions of women across the country. However, the drug is not yet registered in South Africa, and the Minister of Health Manto Tshabalala-Msimang said that she had very little details of the drug company’s offer. A spokesman for the department of health told IRIN that it would examine the results of the study, as the ministry was “not completely convinced of the drug’s safety”.