New drug regimen for HIV positive pregnant women

More effective drugs from next year

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Sonal Matharu | June 23, 2011



To prevent mother to child transmission of HIV, a new regimen for pregnant women and infants will be introduced next year in the national AIDS control programme and changes accordingly will be made in the resective state AIDS control societies, said Dr Faizi O Hasmi, project director, Delhi State AIDS Control Society (DSACS).

Under the new regimen, a single dose of AZT or Zidovudine, 300 mg, will be given twice a day to women who have CD4 count 350 or higher throughout pregnancy and delivery. The medication will start at 14 weeks of pregnancy. And after delivery, Nevirapine syrup will be given to the infant as long as he or she is on breast feeding. The medicine will be given to the infant seven days after stopping breast feeding also to prevent transmission of HIV through breast feed.

“The efficacy of the new drugs is high and will bring down the chances of transmission from mother to child from the present 30 to 40 percent to as low as two percent,” said Dr Hashmi.

Presently, a single dose of Nevirapine is given to women during labour and to infants within 72 hours of birth to prevent transmission of HIV infection.

“The limitation of this drug alone is firstly, its lower efficacy as currently only 50 percent of the babies born to HIV positive mothers are protected from mother to child transmission of HIV. Secondly, the potentially higher risk of development of resistance against Nevirapine in the long run. Eventually, if the mother or the baby need regular antiretroviral treatment (ART) in future, then the standard first line ART regimen containing Nevirapine, costing Rs 5,000 per year needs to be replaced by ARV drugs costing more than Rs 11,500 per year or even more. This development of resistance has specifically been taken care off in deigning the new regimen by the World Health Organization (WHO),” said Dr A K Gupta, additional project director, DSACS.

The new drug is being introduced after an evidence-based study by the WHO. The drugs will be supplied the state AIDS societies by National AIDS Control Organisation (NACO). The new regimen is expected to start from the next plan of NACO which is National AIDS Control Programme (NACP) IV as the drug is also cost-effective.

It will actually save 400 to 500 lives in Delhi if all institutional deliveries where mothers are found HIV positive are covered, added Dr Hashmi.

In 2010-11, out of 1.61 lakh pregnant women counseled and tested in Delhi, 364 were found to be HIV positive. From next year, DSACS aims to test 2.5 lakh women who come for institutional deliveries and put them on the required regime to bring down HIV infection.

An emergency labour room for HIV testing will be introduced to cover 10 percent of total deliveries which land up as emergency deliveries in hospitals, added Dr Gupta.

Given the past records, DSACS is expecting at least 500 HIV positive pregnant women next year out of them, 40 percent will require first regime and full ART for their own health and the rest 60 percent will require the new regime. 

Also, with the new regimen HIV positive mothers can now freely breast feed the infant for more than a year. “It has now been established that breast feeding under the cover of daily single dose Nevirapine to the baby drastically reduces the chances of transmission of HIV through mother's milk,” said Dr Gupta.
 

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