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volume 1 |
november, 1999 |
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congressional taskforce on international hiv/aids |
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5. Prevention of HIV Transmission Using the Drug
Nevirapine In an advancement that promises to significantly reduce the
incidence of AIDS in children in developing countries, American and
Ugandan scientists have found a simple new way to prevent mother-to-child
transmission of the AIDS virus that also is less costly and markedly more
effective than the standard therapy in the third world. The more practical
therapy comes from substituting one marketed drug, nevirapine, for the
standard drug, AZT. The cost for the two doses of nevirapine was $4,
compared with $268 for the AZT regimen now used in developing countries
and $815 for the much longer and more complicated course used in the
United States and other developed countries, Federal health officials said
in releasing the findings yesterday.
The new treatment calls for both a mother and her infant to
take nevirapine just one time -- a mother takes a pill once during labor,
and her baby is fed the drug as a syrup once during the first three days
of life.
Nevirapine, a drug used in combination "cocktail"
treatments, has been marketed since 1996 in the United States for
treatment of H.I.V., the AIDS virus, and it was remarkably safe in the
study that was conducted by American and Ugandan researchers. As babies
reached 3 months of age, nevirapine had cut the risk of mother-to-child
transmission of H.I.V. to 13 percent from the 25 percent for the standard
course of AZT in developing countries, or a reduction of 47 percent,
United States and Ugandan health officials said.
Monitoring will continue for 18 months to determine adverse
effects that might show up later in infancy. The monitoring will also help
to determine how many babies will still become infected through
breast-feeding in the first months of life, when such transmission is
highest.
H.I.V. can be transmitted during pregnancy or during
delivery when bleeding occurs. Nevirapine is believed to be able to block
transmission of H.I.V. during the delivery, and further studies will be
needed to determine if transmission can be stopped during breast-feeding.
Nevirapine targets the same enzyme in H.I.V. as AZT, but it
is a different class of drug.
The low cost of nevirapine makes it feasible for wide-scale
use in many developing countries, Dr. Anthony S. Fauci, who heads the
National Institute of Allergy and Infectious Diseases, predicted in an
interview. His Federal agency paid for the study.
Dr. Peter Piot, who heads the United Nations AIDS program in
Geneva, said the nevirapine study was "a major gain" because it
"approaches ideal prevention therapy" for developing countries, where 95
percent of the H.I.V.-infected people live.
But Dr. Piot said it was "unrealistic to introduce it on a
large scale in developing countries without first using pilot programs"
because drug therapy is only one part of a complex effort to prevent
H.I.V. Such pilot studies will begin soon in developing countries, he
said.
Most women in developing countries do not know that they are
H.I.V.-infected because testing programs are scarce. "It is still a
logistical, economic and cultural challenge to develop programs to
encourage H.I.V. testing, counseling and baby formula as a substitute for
breast-feeding for infected mothers," Dr. Piot said in an interview.
American and Ugandan scientists plan another study to see if
it would be more effective to give nevirapine to mother and infant for
longer periods. Also, a continuing study in the United States and Europe
aims to determine if adding nevirapine to standard regimens will further
lower the transmission rate of H.I.V. from mother to child. Dr. Fauci said
there was no need to change the United States recommendations until more
studies are completed.
The United Nations AIDS group estimates that 1,800 babies
are born H.I.V.-infected every day in developing countries where most
women do not receive prenatal care. In some areas of Africa, up to 40
percent of pregnant women are H.I.V. infected, and from 25 percent to 35
percent of their infants will be born infected if therapy is not provided.
Wide-scale use of nevirapine in developing countries "could
potentially prevent 300,000 to 400,000 newborns each year from beginning
life infected with H.I.V.," Dr. Fauci said.
AZT and other anti-H.I.V. drugs have drastically reduced
mother-to-child transmission of the infection in the United States since
1994, when a federally sponsored study showed that AZT, taken for several
weeks, could stop mother-to-child transmission of H.I.V. The American
regimen calls for the pregnant woman to take AZT five times a day
beginning as early as the 14th week of pregnancy and continuing until
labor, when an intravenous injection of AZT is given. At birth, the baby
takes AZT four times a day for six weeks.
Because the American regimen was impractical and too costly
for third world countries, scientists sought a more affordable therapy.
Researchers initially intended to enroll 1,500 women in the
study, conducted at Mulago Hospital and Makerere University in Kampala,
Uganda, beginning in November 1997. One part of the study was dropped in
February 1998 after another United States-financed study conducted in
Thailand found that AZT used for a shorter period than in the United
States was effective in preventing mother-to-child transmission of H.I.V.
The Ugandan study then involved 618 women in their ninth
month of pregnancy who had not taken anti-H.I.V. drugs and their 631
infants.
Of the 618 women, 308 took AZT and 310 took nevirapine.
Enrollment stopped at the end of last April.
The women agreed to accept by random selection either of two
drug regimens. One regimen was single dose nevirapine therapy for mother
and infant. The other regimen involved taking two AZT pills at the onset
of labor and then one pill every three hours until delivery. Infants born
to mothers who took AZT were given AZT twice a day during the first week
of life.
After two months, 59 infants born to mothers who took AZT
and 35 infants born to mothers who took nevirapine were infected.
Statistical tests projected the 25 percent and 13 percent infection rates,
respectively.
The three deaths that occurred among mothers who took AZT
were due to AIDS and not the drug, the researchers said. No deaths
occurred among the mothers who took nevirapine.
Infection was the most common cause of adverse effects and
death among the infants whose mothers took the two drugs. The adverse
effects and deaths were not deemed drug related.
Scientists learned the findings on Monday at a meeting of a
committee that oversees the safety and effectiveness of such
studies. |
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6. Asia Risks
Surpassing Africa in AIDS Epidemic Without the necessary precautions, Asia could overtake Africa in the
AIDS epidemic by 2005, according to a senior Chinese health official.
Cases of HIV and AIDS in Asia are increasing rapidly, with an annual
growth rate of about 20 percent in 1998,United Nations statistics show.
The fact that India and China are the world's most populated countries
could make AIDS explode in Asia as HIV cases increase.
Xu Hua, associate secretarygeneral of the China Sexually
Transmitted Diseases and AIDS Foundation, stated that a census would be
helpful to determine the extent of the problem, but a lack of resources
was hampering efforts. |
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7. 3.5 million
Indians carry AIDS virus NEW DELHI: Close to 3.5 million people, which is about one per cent of
the adult population, are living with the AIDS virus in India, says the
government, on the basis of scientifically worked-out estimates. This is
the first official figure given by the Indian government. This comes at a
time when international attention is getting focussed on India due to
fears of large numbers of people living with HIV. India, says the World
Bank, has the largest absolute number of people living with HIV.
The release of official estimates are an attempt to check the
circulation of inflated projections on India's HIV epidemic, says project
director of the AIDS control program, J V R Prasada Rao. He says the
estimates have been arrived at by a group of leading epidemiologists in
the world. The data generated by the National AIDS Control Organisation
(NACO) over the last few years has been used for this exercise.
The estimates show that the HIV infection has penetrated to all levels
of the general population. About seven lakh (700,000) of those infected
could be living in rural areas and a large number of women may be among
those infected.
These patterns are seen in the later stages of the spreading infection.
It has been seen that HIV spreads from urban areas to rural areas. In the
beginning of the epidemic, the number of infected men is much more.
Slowly, this ratio gets closer to one.
Officials, however, are reluctant to comment on what stage the epidemic
is at in India. "In India, there are small epidemics on in various
parts of the country,'' says Dr L M Nath one of epidemiologists of the
group, which arrived at the estimates. The highest prevalence of HIV is
being reported from Maharashtra, Karnataka, Tamil Nadu, Andhra Pradesh and
Manipur. In these high prevalence states, the ratio of infected women is
estimated to be high. NACO says for every infected woman there are 1.2
infected men in these areas.
For the full story, please see the Times of India online at: | |||
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8. New Zealand to Bar
Entry to HIV Victims New Zealand will implement a ban on all HIVpositive immigrants starting
July 1,2000. All new immigrants and refugees will be subject to an HIV
test before arriving in the country. Individuals who test positive for the
virus will not be allowed entry. A total of 105 new HIV infections were
recorded in New Zealand last year, including 43 cases among refugees.
Please also see CRS report |
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9. Blair urges
leaders to Intensify AIDS Fight Tony Blair will deliver a blunt message to Commonwealth leaders today
that they must step up their efforts to combat the threat of Aids after a
new government report found that the average life expectancy in some
African countries will fall by 20 years during the next decade.
On the opening day of the Commonwealth summit in Durban, the prime
minister will ask the 53 fellow heads of government to follow the example
of Britain, which is to provide a multi-million pound package to promote
awareness about Aids in sub-Saharan Africa.
Mr. Blair will ram home his message by telling the summit that his
report found that in the nine African countries with the highest rate of
HIV the average life expectancy among men and women will fall during the
next decade from 60 to 40 years.
Before flying out to the conference last night, the Prime Minister
said: "The contents of this report are deeply shocking. This is plainly an
issue that the Commonwealth must grasp and I will be discussing these
findings with my fellow Commonwealth leaders this weekend."
There are 5,500 burials of Aids victims a day, and sub-Saharan Africa,
where many Commonwealth countries are, is being devastated, according to
the report. The region has suffered more than 80% of all Aids
deaths.
In Namibia, Botswana, Swaziland and Zimbabwe, more than 20% of people
between the ages of 15 and 49 are living with HIV or AIDS. In South
Africa, 20% of pregnant women are infected with HIV.
Please see: |
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10. Commonwealth urges
affordable drugs for the poor GEORGE, South Africa - Commonwealth leaders said on Sunday
globalization of the world's economies should ensure the provision of
affordable drugs to the world's poor. The leaders also expressed
concern about the concentration of global research resources on drugs that
offer the most lucrative financial returns.
``We call on the world community to use the opportunities offered by
globalization for adopting practical measures for overcoming these
challenges," they said in a statement at the end of a two-day retreat in
the seaside resort of George, part of the organization's biennial summit
held in Durban. One such measure could be to extend the benefits of
global medical research through the provision of drugs at affordable
prices to the poor, the statement said.
Leaders of the Commonwealth's developing countries, which make up the
vast majority of the organization, were concerned that essential drugs
made in industrialized countries were too costly for poor nations, many of
which were bearing the brunt of diseases such as AIDS.
The 54-nation Commonwealth, a group of mainly English-speaking nations,
many of them former British colonies, also expressed concern at an
increasing international tendency to claim property rights on traditional
knowledge.
South Africa is already embroiled in a drug patent rights row with the
United States over plans to allow local manufacturers to make cheaper,
generic copies of AIDS drugs or import medicines from a third party.
U.S. pharmaceutical firms say the plans violated their patent rights
and threatened future investment into AIDS drugs.
The row was somewhat diffused last month after the U.S. agreed to
support South Africa's efforts on the condition that the measures would
not violate the firms' patent rights.
South Africa has also stopped the use of British pharmaceutical giant
Glaxo Wellcome's AIDS drug AZT in public hospitals, saying it was
costly. Glaxo says however it was offering Pretoria the drug at a 70
percent cheaper price that it charges on the open market.
South Africa is one of the countries hardest-hit by the AIDS crisis
across sub-Saharan Africa. An estimated three million South Africans
have HIV or AIDS, and about 1,500 are believed to be infected with the
AIDS virus every day. | |||
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The Congressional
Taskforce on International HIV/AIDS is a bipartisan group of
Representatives concerned with the spread of the AIDS epidemic in the
world. The task force's purpose is threefold: 1) to share
information about the spread of HIV/AIDS in the world, 2) to examine the
social and economic effects of the disease, and 3) to plan legislative
strategies for improving the U.S. government's response to this world-wide
epidemic. |
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