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R.R.
Frerichs Posting
The current
New England Journal of Medicine (NEJM) brings findings on
still another AZT study, suggesting further cost and effectiveness savings
with short-term treatment of the mother. While some health officials in
Asia may be reluctant to test mothers for HIV antibodies if the benefits
to their offsprings are not clearly apparent, this new research should
assure them that much can be done, even in countries with few financial
resources. The important implication of the NEJM article is that once infected
pregnant women are detected, preferably earlier but acceptable even if
at the time of delivery,then AZT treatment should be started as soon as
possible.
Have others in Asia besides our Thai colleagues experienced similar
success with routine HIV detection among pregnant women, especially with
the use of rapid tests? If so, please share your findings.
"AZT after delivery can prevent infant HIV" News Release. Wednesday
November 11, 1998.
A course of the drug AZT can help prevent HIV transmission from mother
to child even if the drug is first administered during labor and delivery,
or first given to the infant 48 hours after birth, according to a report
in the November 12th issue of The New England Journal of Medicine. The
findings suggest that weeks of prenatal AZT (zidovudine) treatment -- which
is known to substantially reduce the risk of transmission -- is the best
but not the only way to reduce the risk of infected mothers transmitting
the virus to their infants. The findings are especially good news for the
treatment of HIV-infected women in developing countries, which may not
be able to afford weeks of expensive drug treatment for pregnant women.
"The drug-related cost of such prophylactic treatment of infants would
be a fraction (less than 1/10) of that for even a short course of maternal
treatment, "according to an editorial by Dr. Kenneth McIntosh, of Children's
Hospital, Boston, Massachusetts.
In the study of 939 infants exposed to HIV between 1995 and 1997, the
HIV transmission rate was 6.1% when the mother was treated prenataly,
10% where the mother was treated during labor and delivery, and 9.3% for
infants treated in the first 48 hours of life. The transmission rate was
18.4% for those infants treated on the third day of life or later, and
26.6% for those not treated with AZT at all. There are a number of reasons
the women may not have received AZT during pregnancy, according to the
report. "Some women may not receive prenatal care, whereas others who do
receive prenatal care may not be counseled or offered HIV testing," according
to the report.
The new study suggests that even if a woman had no prenatal
care, rapid HIV testing of a newborn may still prevent transmission of
the virus to an infant, reported lead author Dr. Nancy Wade of the AIDS
Institute in Albany, New York, and colleagues.
Study co-author Dr. Guthrie
S. Birkhead told Reuters Health there is a potential role for rapid HIV
testing in the delivery setting. "This has already been discussed somewhat
in the medical literature... and our study shows that, indeed, there may
be some benefit of doing rapid testing in the delivery setting." He pointed
out that because many women are not tested for HIV during prenatal care,
"it makes sense to try to identify these women at the time of delivery."
But to reduce perinatal HIV transmission "to the greatest extent possible,
a combination of efforts is needed to ensure that all pregnant women receive
HIV counseling and are tested for HIV and, if positive, receive prophylaxis
with zidovudine, alone or in combination with other antiretroviral agents,"
the authors conclude.
SOURCE: The New England Journal of Medicine 1998;3391409-1414,1487-1468.
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