Dr Precious Motsoso, Registrar of the MCC, said that nevirapine could still be used to prevent mother to child transmission of HIV provided it was used with another antiretroviral drug such as AZT or another combination.
She said that the manufacturer of nevirapine, Boehringer Ingelheim, would be given a period of time in which to change the package insert which indicated how the medication should be used.
Matsoso emphasized that there was no desire to de-register nevirapine, but simply that the package insert needed to be amended ‘to reflect the current science’.
Monday’s announcement has surprised scientists and caused considerable confusion among delegates at the International AIDS conference, particularly as the South African government is due to hold a national consultative conference after the Bangkok meeting at which all evidence about resistance will be discussed.
Dr Glenda Gray, director of the Perinatal HIV Research at Chris Hani Baragwanath Hospital, said scientists had kept health officials abreast of scientific developments regarding nevirapine since they first presented data about resistance two years ago.
‘We sent our data to the Department of Health and presented it to MinMEC two weeks ago. They said that after Bangkok there would be a national consultative meeting,’ she added.
Gray will present research findings to the International AIDS conference that show that resistance to nevirapine can be diminished significantly by giving the drug Combivir (AZT + 3TC) to mothers for either four or seven days after they have given birth.
Gray said the study, known as the Boehringer Ingelheim 14-13 Study, was ongoing but that it showed that nevirapine could still be very effective in the prevention of mother to child transmission if other drugs were added.
She welcomed government’s commitment to review all available HIV interventions and said this gave the health community the chance to find the best regimen to eradicate the transmission of HIV from mothers to children.
‘Wherever there are HIV positive children,’ we have failed,’ she said. ‘We are thrilled with the prospect of more potent regimens, but women should not be without interventions while we are in a quandary about what to give women and children.’
Gray said the timing of the MCC statement was regrettable. Scientists and policy makers were in Thailand while the nurses who administer the treatment and women who are receiving it are in South Africa.
‘There will be a loss of confidence in the PMTCT programme, it’s unfortunate because I’m not there to troubleshoot in South Africa,’ Gray added.
Asked why she had chosen the first working day of the conference to make the MCC announcement, Dr Motsoso said the Council wanted to be seen as proactive in anticipation of various scientific sessions at the conference which would present findings on this matter.
Treatment Action Campaign deputy chairperson Sipho Mthathi said it was common knowledge that a single dose of nevirapine caused resistance among some women and that there were better regimens.
‘The MCC’s recommendation is not news. What is problematic is the way it has been communicated by the MCC and by the minister.
‘Its impact on the ground and on people who are faced with the decision to take nevirapine is to produce fear and panic – and that undermines the whole MTCT programme,’ she said.
Approximately one million women give birth in South Africa each year ‘ of these a quarter or 250 000 are HIV positive.
‘This means that almost 700 HIV infected women give birth a day,’ said Gray. ‘Of those about 25 percent are identified [for PMTCT]. If only we had 100 percent coverage. The clock is ticking.’
E-mail Sue Valentine