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Reducing HIV Transmission

Researchers report encouraging results from a follow-up study of a new drug aimed at reducing the transmission of HIV from infected mothers to their newborn children.//

Health officials estimate in 2002 about 800,000 children around the world were infected with HIV through mother-to-child transmission. More than 90 percent of these cases occurred in underdeveloped nations.

The incidence is much lower in developed countries because HIV-infected mothers are routinely treated with the anti-HIV drug zidovudine during pregnancy and labor, and their infants receive the drug during the first six weeks of life. This treatment, however, is generally considered too complicated for use in less developed countries.

In 1999, investigators, working with health professionals in Uganda, reported positive results from the use of a new drug called nevirapine when administered to infected mothers once during labor and to infants one time within 72 hours of birth. The treatment was compared to a treatment regimen with zidovudine given at labor onset and every three hours until delivery to the mother and twice daily to their infants for seven days.

The current study followed the infants up to 18 months of age. Results showed the 8.2-percent reduction in HIV transmission that was seen for infants on nevirapine at six to eight weeks in the original study was sustained at 18 months. They conclude, "This simple, inexpensive, well-tolerated regimen has the potential to significantly decrease HIV-1 perinatal transmission in less developed countries."

However, researchers say resistance to single-agent anti-HIV drugs often develops and suggests more needs to be done to prevent transmission of HIV from infected mothers to their newborn children.

Suboptimum single-agent and double-agent prophylaxis protocols no longer have a justifiable place in the front lines of the global struggle against HIV/AIDS. It is up to all of us to focus on developm ent of equitable distribution and effective use of these agents now.

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