Breakthrough drug prevents mother-to-child HIV transmission

For a pregnant mother with the human immune-deficiency virus, the fear of transmitting the HIV to her unborn child can be very unbearable. This fear should now be abated.

A breakthrough drug which can prevent the mother-to-child-transmission (MTCT) of the HIV is now locally available. Nevirapine, a potent anti-HIV drug marketed under the brand name Viramune by Boehringer-Ingelheim, has been shown to be a well-tolerated, effective and affordable option in reducing the incidence of MTCT of HIV. It can help fill a critical need in developing countries like the Philippines where the United Nations’ Acquired Immune-deficiency Syndrome (UNAIDS) Agency estimates approximately 1,800 HIV-infected babies are born everyday.

"Nevirapine, which has been studied in women in Uganda and South Africa, holds great promise for reducing MTCT in the developing world because it represents a short and simple regimen, which can be easily administered in a resource-poor environment," said Dr. Brooks Jackson, consultant at the John Hopkins University and principal investigator of nevirapine.

The study conducted in Uganda showed that a simple regimen – one oral dose of nevirapine (Viramune) given to HIV-infected women in labor and another to their newborn babies within three days of birth – was effective in reducing MTCT.

The Lancet, a prestigious international medical journal, has reported that nevirapine is a most cost-effective, efficacious and easily administered drug available at present for the prevention of MTCT, and gives hope to a new generation to be born HIV-free.

Newborn HIV infection

A recent article in the same journal presents hope for reducing newborn HIV infections in developing countries. Findings indicated that anti-viral intervention with drugs like nevirapine can have a significant impact on the prevention of MTCT.

Researchers have been investigating nevirapine since 1997 for this important use. The outcome of these investigations encouraged the World Health Organization (WHO) to place nevirapine on its "Model List of Essential Drugs for MTCT" in December 1999.

HIV which causes AIDS has brought about a global epidemic far more extensive than what was predicted even a decade ago. UNAIDS and the WHO have estimated that the number of people afflicted with HIV or AIDS at the end of 2001 stands at 40 million.

HIV in Southeast Asia

Southeast Asia has one of the highest HIV-related cases reported in the world. To date, there are 780,000 documented HIV-related cases in the region. However, the National HIV Sentinel Surveillance System (NHSS) has reported only 1,464 HIV-related cases from 1984 to February 2001 in the Philippines, one of the lowest prevalence of HIV infection in Southeast Asia. Yet, it is believed that there are still a lot of unreported cases which can bring the rate at an alarming level.

AIDS is an incurable disease of the immune system characterized by life-threatening diseases including candidiasis, pneumonia, herpes and tuberculosis, to name a few. The syndrome is caused by HIV which can be transmitted through body fluids, notably blood and semen, through sexual contact, sharing of contaminated needles and transfusion of infected blood.

When AIDS was detected on 1981, the widely accepted notion was that the virus attacked only homosexuals and Caucasians. But medical researches have shown that no one is safe from the virus, even a newborn child.

Globally, MTCT during pregnancy, delivery or breast-feeding is a second major mode of spread of HIV. Studies on perinatal transmission of HIV indicates that developing countries like the Philippines are more likely to transmit AIDS through this mode of transmission.

One factor which may play a role in this higher risk of infection for the Philippines is breast-feeding, which is much more common here than in the industrialized world. Studies showed that the risk of transmission through breast-feeding may be as high as 50 percent when the mother becomes infected during late pregnancy or after delivery.

Risk factors

The likelihood that an HIV-positive mother will give birth to an infected child ranges from less than five percent to as much as 30 percent. Several factors in the mother contribute to this broad range in transmission risk, namely, stage of HIV, intake of anti-HIV medications, and effectiveness of these medications in suppressing viral replication.

The advancement in the medical community has created new medications for the control of HIV and has helped many HIV patients live healthier lives. It has allowed HIV-positive couples to contemplate the future with greater optimism and confidence and make long-term plans.

With increasing frequency, these plans include the possibility of conceiving, bearing and raising children. A growing number of doctors are helping HIV-positive couples to have babies using potent medications that promise to reduce substantially the risk of transmitting HIV to their offsprings.

In its objective to prevent MTCT, Boehringer-Ingelheim International has launched the "Viramune MTCT Donation Program" where the anti-AIDS drug Viramune is offered free of charge to all developing countries for a period of five years.

"This global program represents a real turning point in the fight against HIV/AIDS in the developing world," said Prof. Dr. Rolf Krebs, vice chairman of the board of managing directors at Boehringer Ingelheim. He said this is the first time that both the public and private sector are joining forces to implement a major change in the care of HIV/AIDS in the developing world.

In the Philippines, Boehringer Ingelheim has offered the Department of Health a discount of 70 percent for Viramune tablets for the chronic therapy of (+) HIV patients. It has also offered free of charge Viramune for the MTCT indication.

The DOH has expressed positive response to this initiative, saying this will enable the department to put more HIV-positive patients on nevirapine.