World experts give antiretrovirals the go-ahead

Medication shortages at Gauteng facilities
Covid-19 has concerning impact on HIV and TB targets (File Photo)

The Joint United Nations Programme on AIDS and World Health Organisation (WHO) today (wed) backed the use of antiretroviral drugs to prevent mothers from transmitting HIV to their babies, saying that “the benefits outweigh the potential adverse effects”.

This paves the way for the South African Medicines Control Council (SAMCC) to finally register nevirapine to prevent mother-to-child transmission (MTCT).

Since July, the MCC has been considering the licensing of nevirapine, a drug that could cut HIV transmission from a mother to her baby by half at a cost of about R30 per woman.

MCC chairperson Dr Helen Rees said earlier this week that her council was “still reviewing the evidence and awaiting some further responses from international agencies” before licensing the drug.

However, it now seems certain that nevirapine will be licensed, and the health ministry has instructed all nine provinces to make the drug available in at least two “research sites” per province to look at the “operational challenges” of administering nevirapine.

Experts convened by the UNAIDS and WHO reported that the use of zidovudine (AZT), a combination of AZT and lamivudine (3TC) and nevirapine “does not have any adverse effects on the health of the mother (or the) growth and development of infants”.

“We welcome these new recommendations, particularly those relating to nevirapine,” said Dr Awa-Marie Coll-Seck, UNAIDS policy director.

The experts described the use of nevirapine as the “simplest regimen”. All that was needed was a single dose for the mother when she went into labour and a single dose for her newborn baby to cut the risk of HIV transmission by at least half. AZT was described as “the most complex regimen”.

At present, the Western Cape government is giving free AZT to pregnant Khayelitsha women with HIV. However, the province’s chief director of health, Dr Fareed Abdullah, said the programme “was not wedded to one drug” and that it was investigating the use of nevirapine.

One of the concerns raised by the health department about nevirapine was the development of drug resistance.

However, according to UNAIDS and WHO, “evidence indicates that the virus containing drug resistant mutations decreases once the anti-retroviral drugs are discontinued”.

The UNAIDS/WHO announcement comes a day after Health minister Manto Tshabalala-Msimang once again described antiretrovirals as “toxic”.

Speaking at the launch of the health department’s guidelines for combating HIV, Tshabalala-Msimang said that “there is a narrow view again that continues to associate prevention of mother to child transmission of HIV with the use of antiretrovirals only. We know there are other medical interventions . . . We know they [antiretrovirals] are toxic.”

She claimed that vitamin supplements and vaginal cleansing with antiseptics during pregnancy could reduce the HIV infection rate of babies. Health-e News.

 

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