2 Drug Anti Aids Combo

[eric1000]

Two-drug combo yields success in Thai HIV study

Catherine Brahic

18 February 2004

Source: SciDev.Net

Researchers in Thailand have found that a combination of two drugs can cut the transmission of HIV from pregnant women to their babies to less than one in 50 (or just 2 per cent).

The treatment is three times more effective than the single-drug regimen currently used in Thailand, which reduces transmission to 6.3 per cent. In the absence of any treatment, more than a third of babies born to HIV-positive mothers develop the disease.

"This is a very important advancement which brings us closer to eradicating paediatric AIDS [in Thailand]," says Vallop Thaineau, permanent secretary of health at the Thai Ministry of Public Health, and a researcher in the study, which also involved French and US scientists.

The findings were publicly released by lead researcher Marc Lallemant of the French Institute of Research for Development (IRD) at an AIDS conference in San Francisco last week. The Thai government ? which was given advance notice of the results last year ? has already decided to implement the new treatment programme.

The study, known as the Perinatal HIV Transmission Programme, involved more than 1,800 HIV-positive pregnant women in 37 hospitals across Thailand, who were given one of three treatments.

All groups received the standard treatment used in Thailand, namely the antiretroviral drug zidovudine (AZT), which is given to HIV-positive women in the latter stages of pregnancy, during labour and delivery, and to newborns for the first week after birth.

Women in the second group were also given a single dose of nevirapine at the onset of labour. And in the third group, both mothers and infants were given one dose of nevirapine in addition to the standard treatment.

The rate of transmission from mother to baby was 6.3 per cent with the standard treatment, 2.8 per cent in the second group and 2.0 per cent in the third group.

"The data from the Thai study are encouraging," says Ward Cates, president of Family Health International. "They show that a relatively simple two-drug 'preventive' regimen can be ? more effective than the use of single-dose nevirapine [in reducing mother-to-child transmission]."

He adds: "The issue will be how to support the production and distribution costs of an extra drug to low-resource areas."

The study raised one additional concern, in that one in five women who received nevirapine were found to develop resistance to the drug. This could reduce their chances of later fighting the illness using triple-drug therapies that include nevirapine.

Sophie Le Coeur, an epidemiologist involved in the study, told SciDev.Net that the research group is now looking into the problem of resistance. "The priority right now is to save the children. There are other solutions for the mothers," she says.

Marie-Louise Newell of the UK Institute of Child Health agrees that concerns about resistance should not affect treatment recommendations. "The benefits of single dose nevirapine in reducing mother-to-child transmission far outweigh the poorly quantified potential adverse affects on the small proportion of women who need treatment soon after delivery," she says.

More than 1,500 newborns are born with HIV every day, and 95 per cent of these live in developing countries where monthly triple therapies commonly taken by pregnant mothers in industrialised nations are not affordable.

[Suzy]

Researchers in UK discovered several years ago that a cocktail of three drugs was far more effective against HIV than a single drug. Why isn't Thailand following suit?

[Digger]

Researchers in UK discovered several years ago that a cocktail of three drugs was far more effective against HIV than a single drug. Why isn't Thailand following suit?

Because this is to prevent mother to baby transmission , not a fully fledged treatment regime. Historically, AZT has been used on its own to prevent transmission in childbirth in many countries not just Thailand.

[Suzy]

Sorry to query your message but AZT alone has not been used as a solo treatment for HIV whether to prevent transmission or as a fully fledged treatment for several years. If the mother is HIV positive she should be on a cocktail that reduces the VL to a level where it may be hopeful that HIV will not to be passed on to a baby. This is extremely doubtful as there is no guarantee the virus will not be passed on, if the mother has it the baby most probably will.

To quote an expert:

"In truth, AZT makes you feel like you’re dying. That’s because on AZT you are. How can a deadly cell toxin conceivably make you feel better as it finishes you, by stopping your cells from dividing, by ending this vital process that distinguishes living things from dead things? Not for nothing does AZT come with a skull and cross-bones label when packaged for laboratory use." - Anthony Brink, AIDS researcher

[Digger]

Sorry to query your message but AZT alone has not been used as a solo treatment for HIV whether to prevent transmission or as a fully fledged treatment for several years. If the mother is HIV positive she should be on a cocktail that reduces the VL to a level where it may be hopeful that HIV will not to be passed on to a baby. This is extremely doubtful as there is no guarantee the virus will not be passed on, if the mother has it the baby most probably will.

To quote an expert:

"In truth, AZT makes you feel like you’re dying. That’s because on AZT you are. How can a deadly cell toxin conceivably make you feel better as it finishes you, by stopping your cells from dividing, by ending this vital process that distinguishes living things from dead things? Not for nothing does AZT come with a skull and cross-bones label when packaged for laboratory use." - Anthony Brink, AIDS researcher

If you read the story in full, its states quite clearly that AZT is and has been the staple treatment for expectant mothers in Thailand. In Thailand, you can obtain a generic copy of AZT which is FAR cheaper than the GSK original and this treatment presumably has a lot to do with cost. Dont forget a lot of females in Thailand only discover they are HIV positive during pregnancy as its a standard test undertaken - these are not always long term treatment experienced patients and many of them are not even considered as being required to go on medicine either as their CD4 counts are over 250 and their viral load is below 50-100,000. Top line treatments in Thailand cost upwards of 10,000 baht per month and there are not many that can afford that, hence the use of stand alone AZT.

Therefore the use of AZT has been successfull as a stand alone treatment in ensuring that some 94% of babies are born without HIV from a HIV positive mother - hardly a mortifying failure rate and the use of nevarapine has only increased that rate to about 96%. However Nevarapine is expensive in Thailand - far more so than just AZT and if you add a 3rd treatment such as 3TC the costs will go up even more.

Also the point about AZT is old news and scaremongering at best. Ask the 94% of mothers who have HIV free babies how they feel? Without AZT, HIV treatment would not be where it is today. AZT stills forms the cornerstone of the majority of treatments recommended by doctors in the western world including the USA and UK. The reason people died many years ago was that the dosage was far too strong. Doctors kept upping the dose (often to 900mg a time) when it was not working, given that it was the ONLY drug available then. Now they know that 300mg's in combination with other treatments works very well and has hardly any side effects. Coupled with 3TC into Combivir/combid as a twice daily single pill has been a HUGE achievement and meant that difficult multi tablet regimes have been far simplified. The use of single day dosage stockrin as the 3rd element is now considered the Mercedes Benz of treatments for treatment naive patients and many have been on this medication for at least 3 years with fantastic results. Meds are easy to take, in most circumstances and not so restricted about empty/full stomachs etc, no need for refrigeration etc.

By all means steer clear of AZT if thats your preference but please don't put horror stories into peoples minds where they are not proven to exist based on TODAY'S treatment options. Incidentally, AZT is not used as a stand alone treatement for HIV patients in Thailand other than expectant mothers that are not on other medical regimes at the time of birth.

[Suzy]

Facts are facts!

Top line treatments are not available in Thailand.

If you're worried about horror stories, I suggest you read the list of side effects issued by the drug companies with their medications. It could put anyone off their medication.

My top line medication excluding what is not available in Thailand currently runs at a cost of nearly half a million baht a year. Only one of the cocktail is available generically here, all others are imported as they are not available. All hospitals do not carry stock of all if many and in the past I've been frequently left without one or another.

[Digger]

Facts are facts!

Top line treatments are not available in Thailand.

If you're worried about horror stories, I suggest you read the list of side effects issued by the drug companies with their medications. It could put anyone off their medication.

My top line medication excluding what is not available in Thailand currently runs at a cost of nearly half a million baht a year. Only one of the cocktail is available generically here, all others are imported as they are not available. All hospitals do not carry stock of all if many and in the past I've been frequently left without one or another.

Suzy - I dont see any facts that you have presented.

If you have supply problems - seek out a better hospital/doctor and read through my answer to your other post. I really dont see what your getting at by your reply. All HIV drugs are very powerfull and carry side effects - but everyone knows that which is why even in Thailand they are not available over the counter of a pharmacy. The newest drug regimes are developed to minimise side effects and be easier to take which is great news for anyone in that position of needing these drugs to stay alive.

Thailand is not unique in the world by not offering free drugs, even in the UK, which has one of the most generous drug treatment guidelines, some cancer drugs are still not available due to cost issues. However MOST HIV drugs are available here and invariably at far lower prices than in the west even if they are the same imported medicine. For example Combivir in Thailand costs around 160 baht per tablet. In the UK it costs 5 times that much.

[Suzy]

In Thailand, if you go to the right pharmacy, HIV drugs are available across the counter.

In the UK treatment for HIV patients is often free.

[et33.com]

[Digger]

In Thailand, if you go to the right pharmacy, HIV drugs are available across the counter.

In the UK treatment for HIV patients is often free.

Selling hiv drugs in Thailand is illegal unless the pharmacy is issuing from a doctors prescription - Im sure there will always be some stores that try and do get round that, but for how much longer I wonder - already its getting more and more difficult to get normal antibiotics over the counter of a drug store in Thailand and with good reason.

Sorry about the point of drug costs in UK, your right its free (or heavilly subsidised via prescrption charge) to the end user, just the tax payer that picks up the costs of the mediines and that is the price they are paying relative to every combivir tablet - unfortuantely no such luxury in Thailand even on the 30 baht health scheme as the range os drugs is very limited and prone to side effects.