A source at Boehringer told Positive Nation that
everyone agreed that the halving of transmission rates documented by
HIVNET was real. However, imposing Western standards of clinical evidence
to a rural African setting had proved problematic. Monitoring of patient
identity in a semi-literate population was poor, and African and US authorities
found it difficult to agree on the level of 'adverse events', ie drug
side effects. "They were dealing with mothers who were often quite
ill already," the spokesman explained, "and it was difficult
to establish if any illness was related to the treatment."
This occurs just as the South African Constitutional Court has ruled that
its government cannot prosecute doctors for giving two-dose nevirapine
to mothers and babies. An appeal by the government is due on 2 May, and
the government has responded in a statement which - while going on record
as saying that "HIV is the cause of Aids" - says that it will
do nothing till its own investigations are concluded in December.
Meanwhile the PETRA trial, in three African countries, gave AZT and 3TC
to mothers and babies immediately before and for a week after birth. It
found that, although the regime reduced MTCT rates from 15 to 9 per cent,
this advantage was almost wiped out by breastfeeding. By the time the
baby was 18 months old, transmission rates were up to 22 and 18 per cent
respectively.
The study team said: "Regimes to prevent MTCT of HIV in less-developed
countries should minimise the risk of subsequent transmission via breastfeeding."
But the accompanying editorial went a lot further. Dr Karen Beckerman
of the
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University of California pleaded that HIV drugs must go as much to the
