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Drugs protect breast-fed babies - study
Adele Sulcas. 17 July 2003. Cape Argus. Republished courtesy of Independent Newspapers (Pty) Ltd.
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Results of the first study to demonstrate protection in newborn infants against HIV transmission from breastfeeding by their HIV-positive mothers show a dramatically lowered risk of HIV transmission to babies taking either of two drugs during the entire breast-feeding period.
Only 1% of the children became infected with HIV during the breastfeeding period, rather than the 15% who usually become infected via breastfeeding without drug intervention.
This has important implications for HIV-positive mothers in resource-poor settings such as sub-Saharan Africa where not breastfeeding is regarded as "a sign of infection".
The results of the study, called Simba, or Stopping Infection from Mother-to-child via Breastfeeding in Africa, were described at the 2nd International AIDS Society conference in Paris, being held this week.
The Simba study enrolled 397 infants in two hospitals in Kigali, Rwanda, and Kampala, Uganda. The pregnant women were given a short combined course of Zidovudine (AZT) and Didanosine (DDI) from 36 weeks to one week after delivery, and the infants were given, from birth, either Lamivudine (3TC) or Nevirapine during the full breastfeeding period plus an additional four weeks after weaning.
Mothers were also given intensive counselling about "only breastfeeding", as it has been shown, much to researchers' consternation, that "mixed feeding", a combination of breastfeeding and formula, actually increased the risk of HIV-transmission to babies through breast-feeding.
In Rwanda up to 90% of women breastfeed, said Dr Joseph Vyankandondera of the Centre Hospitalier in Kigali, so it was important to find something that would allow mothers to breastfeed and "not be stigmatised".
In addition, in settings where women often have several children, this new study, which uses different drugs for the mothers and the babies, prevents the risk of nevirapine resistance in the mothers after the first baby. Previous studies have shown that nevirapine, while extremely effective in prevention of mother-to-child transmission during birth, encourages resistance to the drug's effectiveness if mothers use it a second time.
This means that the new babies' regimen allows mothers to "leave their options open", said Dr Joep Lange of the International Anti-viral Therapy Evaluation Centre in Amsterdam, and lead investigator of the study, to be able to have more children and maintain the effectiveness of the HIV infection prevention.
Asked whether this regimen should immediately be implemented in resource-poor settings, Lange said that "the ideal" would be for all mothers to be on anti-retroviral therapy during pregnancy, which on its own would greatly reduce the risk of transmission to infants. However, in settings where this was not possible, "if prevention of MTCT is the only thing we can do, we should definitely be implementing this straight away".
The cost of this regimen would be "virtually nothing", Lange said, given that the manufacturer of Nevirapine (Boehringer Ingelheim), which has already offered free nevirapine to developing countries for mother-to-child transmission, would probably be willing to extend this to cover this new type of treatment for the same purpose.
Even if they didn't, the cost of the Nevirapine syrup used for the babies during breastfeeding would amount to "a few dollars". The problem, Lange added, was not the cost of the drugs, but the willingness of developing country governments to accept the offer of the free drug and implement prevention of mother-to-child transmission programmes. |
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