Pregnant South Africans Key to Slowing AIDS
Washington Post Friday , June 16, 2000
By David Brown, Washington Post Staff Writer
If all pregnant women in South Africa took a short course of antiviral medicine during labor, as many as 110,000 new cases of
AIDS virus infection could be prevented over the next five years. The cost would be minimal, and the effect would be large
enough to slow the country's falling life expectancy.
Those are among the conclusions of a study published in this week's issue of The Lancet, a European medical journal. South
Africa, with 12 percent of its population now infected, has one of the more explosive national AIDS epidemics in the world.
"There is actually a measurable demographic benefit from this kind of intervention," said Evan Wood, an epidemiologist at St. Paul's Hospital in Vancouver, Canada, who made the projections.
But while programs to prevent mother-to-child transmission of the AIDS virus are within financial reach, treating people already infected with the human immunodeficiency virus (HIV) appears to be beyond it.
Wood and his colleagues estimated it would take 13 percent of South Africa's total health spending (from both government and private sources) to provide state-of-the-art antiviral treatment to one-quarter of the people now infected with the AIDS virus. The prediction assumed that "triple therapy" would cost about $8 a day for three medicines--less than one-third what it costs here. Each year of life "gained" over the next five years would cost about $15,000.
In contrast, treating all pregnant women with antivirals would consume less than one-thousandth of a percent of national health spending. The cost per year of life gained would be $19. Anything below $50 is traditionally viewed as cost-effective for health
care interventions in developing countries.
Neither estimate included costs for HIV testing and counseling, or the laboratory infrastructure necessary to monitor people on triple therapy. Those costs can be more than those of the drugs.
In May, five pharmaceutical companies said they would "improve significantly" the access of developing nations to antiviral
medicines. Their announcement came after negotiations with officials from United Nations, the World Health Organization and
UNAIDS, the international AIDS agency. Although the magnitude of future price cuts wasn't specified, many observers hope
antiviral drugs will eventually be sold at manufacturing cost to poor nations.
"The 7 or 8 dollars a day is, I think, well above cost," said Robert S. Hogg, the Canadian epidemiologist who oversaw Wood's study. For discounts to have an effect in Africa, he said, "They'll have to go a lot lower than that to make it [triple therapy] attainable."
The researchers projected that life expectancy in South Africa will be 46.6 years in 2005 if antiviral drug use by pregnant
women remains negligible. It would be 46.8 years if 25 percent of pregnant women were treated; 47.2 if 75 percent of women
were treated, and 47.5 if all were.
Mother-to-child transmission of HIV occurs about 35 percent of the time in breast-feeding populations. Short courses of
antiviral drugs can cut that by about half. The simplest regimen designed so far consists of a single dose of the drug nevirapine
given to the mother during labor and a single dose given to the newborn.
In a study in Uganda published last year, only 13 percent of babies who had been assigned to the nevirapine regimen were
infected at four months.
Nevirapine is now being studied in a clinical trial in South Africa. The safety of the drug and, antiviral drugs in general, have been questioned by some high-ranking officials, including the health minister. Consequently, there may be obstacles other than cost or medical infrastructure standing in the way of prevention campaigns.
In Botswana and Zimbabwe, two of South Africa's neighbors, one-quarter of pregnant women are infected with HIV at some urban clinics. South Africa's epidemic appears to be several years behind theirs, said Joshua A. Salomon, an epidemiologist at the WHO in Geneva.
© 2000 The Washington Post Company