Tamar Kahn
31 January 2008
Cape Town — The Treatment Action Campaign (TAC) yesterday gave a cautious welcome to new government guidelines for preventing mother-to-child HIV transmission, saying they contained improvements but fell short of World Health Organisation (WHO) recommendations.
According to the AIDS lobby group, more than 60000 babies are infected with HIV every year.
The guidelines, issued on Friday , say all HIV-positive pregnant women are to be treated with two drugs: a short course of AZT from the 28th week of pregnancy and a nevirapine pill during labour.
Their babies will get a dose of nevirapine syrup and seven days of AZT, which will be more effective than nevirapine on its own, standard treatment in all provinces except Western Cape, which introduced dual therapy three years ago.
The guidelines recommend routine HIV tests for all pregnant women visiting antenatal clinics, with all babies born to HIV-positive mothers screened for the virus at six weeks and 18 months.
But the new protocols make no change to the threshold for starting long-term therapy, saying treatment for HIV-positive expectant mothers should begin only when their CD4 count falls below 200, not 350 as AIDS activists have called for. A CD4 count reflects the strength of the immune system, which weakens as HIV progresses. The guidelines do not include using extra drugs to reduce the risk of nevirapine resistance for mothers, which the WHO proposed in 2006.
The TAC said yesterday Health Minister Manto TshabalalaMsimang often expressed concern at possible nevirapine resistance in women participating in guidelines programmes. Her decision not to include measures to reduce this risk "made little sense". A post-delivery week-long course of AZT and lamivudine, known as the "cover-the-tail strategy", should have been included for mothers .
This strategy was "strongly recommended" by HIV paediatricians, who advised the health department on the new protocol , the activists said.
Health department spokesman Sibane Mngadi told Business Day last week the guidelines did not recommend providing extra drugs to mothers to minimise nevirapine resistance as there were not enough scientific data on the strategy. "It will be taken into consideration when more tangible scientific evidence is available," Mngadi said. The new guidelines would cost R28,1m to implement in 2008-09.
The TAC expressed disappointment at the decision to leave unchanged the threshold for initiating antiretroviral therapy. The expert committee advising the department recommended expectant mothers get treatment if their CD4 counts fell below 350.
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