WEDNESDAY, Oct. 13 (HealthDay News) -- New research suggests
that alternative drug regimens in poor countries could help
HIV-infected mothers and their infants more effectively fight off
the virus that causes AIDS.
Currently, doctors lower the risk of transmission of
mother-to-baby HIV infection by giving a drug to mothers right
before birth and to babies right after. About half of the babies
avoid getting HIV, but mothers and babies who do get infected often
develop resistance to the drug, which is typically given to them
later in life.
Enter the alternatives. "We now have a very effective treatment
for women who've taken a specific drug and for babies at risk,"
said Dr. Shahin Lockman, lead author of one of two studies about
the regimens in the Oct. 14 issue of the
New England Journal of Medicine.
There's a big hitch, however: the alternative regimens are much
more expensive than the current drug regimen, although the study
authors weren't able to give an estimate of the difference in costs
between the regimens.
At stake are the lives of hundreds of thousands, perhaps
millions, of women who are infected with HIV, said Lockman, an
assistant professor at Harvard Medical School.
In many cases, HIV-positive women in poor countries -- such as
those in Africa -- receive treatment with the inexpensive anti-HIV
drug nevirapine shortly before they give birth. The idea is that
the drug will reduce the risk that the baby will become infected
with HIV during labor and delivery.
The problem is that in some cases, the AIDS virus develops
resistance to the drug and the drug then doesn't work as well after
an initial treatment. Even so, nevirapine is still used to treat
both mothers and infected babies after birth.
Researchers have been looking for alternative treatments that
have less risk of failing because the virus can escape the drug's
effects. In the new studies, they tested different regimens, trying
to find the ones that will allow more mothers or babies to push the
level of HIV in their blood to zero. (They won't be cured if that
happens, but they will stave off the development of the
In one study, researchers gave either of two treatments to 241
African women who'd taken a single dose of nevirapine at least six
months earlier. Twenty-six percent of those who took a regimen that
included nevirapine either died or failed to beat back the virus,
compared to 8 percent of those who took the other regimen. The
regimens were nevirapine plus tenofovir-emtricitabine or
ritonavir-boosted lopinavir plus tenofovir-emtricitabine.
In the other study, researchers tested two regimens --
zidovudine and lamivudine plus nevirapine, or zidovudine and
lamivudine plus ritonavir-boosted lopinavir -- in HIV-infected
babies aged 6 months to 3 years. Only about 60 percent of the
babies on the nevirapine regimen managed to both beat back the
virus and survive, compared to about 78 percent of the other
The results in the babies were so clear that the researchers
ended their study early. Another study, which hopes to determine
the best treatment for infected babies who didn't get nevirapine at
birth, is continuing.
Nevirapine by itself is inexpensive, but many pregnant mothers
in poor countries still aren't given it to prevent transmission to
their babies, said Dr. Paul E. Palumbo, lead author of the second
study and director of the International Pediatric HIV Program at
Dartmouth-Hitchcock Medical Center.
The cost will be a big challenge to providing the alternative
regimens, both researchers say. "When you're already struggling to
provide drugs and then you goose the cost dramatically by changing
the regimen, it really requires a lot of creativity and
problem-solving," Palumbo said. "It could take years for even the
beginning of implementation, and many years before it's more
Still, Lockman -- the lead author of the study of mothers --
said there's a "moral and ethical obligation to try to help the
mothers who put their health on the line to prevent their babies
from getting infected."
As for nevirapine, it is problematic but remains "a very useful
drug, and there are many solutions to this problem," said Dr. Marc
Lallemant, an AIDS specialist at Harvard School of Public Health
and co-author of a commentary accompanying the study. "The bottom
line is that it is an absolute priority to avoid HIV infection in
children in the first place."
Avert.org has details about
mother-to-child HIV transmission.