South African Scientists Calls on Government to Expand Access to Nevirapine in Letter to Lancet
In a letter appearing in the March 23 issue of the Lancet, 22 of South Africa's leading AIDS experts call on the government to expand access to nevirapine to prevent mother-to-child HIV transmission. "In a developing country such as South Africa, the few opportunities for controlling HIV spread need to be maximized," the group states, noting that the scientific evidence supporting the safety and efficacy of the drug is "incontrovertible." Under a Pretoria High Court order, the government has until March 31 to devise a comprehensive plan to combat vertical HIV transmission. The government has appealed the court's order, but the court ruled earlier this month that health officials must proceed with a plan to distribute nevirapine, even while their appeal is pending (Agence France-Presse, 3/21). The government has argued against providing the antiretroviral drug, citing concerns over "cost, toxicity, drug resistance, breastfeeding and the capacity of the health service to implement programs." The group of scientists notes that the cost of nevirapine and the necessary health infrastructure "may be considerable but need to be weighed against those of not providing this intervention (lives lost and treatment of HIV-positive children)." They state that in 2000, 75,000 infants were born with HIV infection and note that about 50% of those infections could have been prevented through the administration of nevirapine. They add that concerns about the drug's toxicity are not valid because several studies have determined that the drugs are "safe with minimum side effects." The scientists also note that drug resistance in the mother "does not affect the efficacy of antiretroviral prophylaxis to prevent vertical transmission," adding that although HIV can be transmitted through breastfeeding, women "can be assisted to make breastfeeding safer" through counseling and formula-based interventions.
Infrastructure is Capable
As to the capacity of the health system to deliver nevirapine, the scientists state that several public health facilities are already capable of administering the drug, and it would be "ethically and morally unacceptable" for the government to deny women nevirapine until the government's questions regarding the drug are satisfied through tests at 18 pilot sites. They add that in settings that do not have the same resource capacity, "less resource-intensive alternatives could be considered while resources and training are provided to address operational inadequacies" (Karim et al., Lancet, 3/23). Lead author Salim Abdool Karim, a world-renowned clinical epidemiologist and professor at the University of Natal, said that the scientific evidence "is clearly in support of providing nevirapine." He added, "If there are other reasons why the government can't do it, that's something else. But we've given a set of arguments that show the scientific evidence is solid" (Agence France-Presse, 3/21).