International HIV Treatment Issues

Boehringer-Ingelheim Works to Make Nevirapine Available to Prevent Mother-to-Child Transmission of HIV

The debate around pharmaceutical companies providing antiretroviral medications for third world countries at low cost has stirred great interest in the HIV policy and advocacy arena. It has allowed examination of what programs are available that provide seriously affected countries with the necessary medications to treat AIDS or related opportunistic infections. Last year, Boehringer-Ingelheim provided its drug, Viramune, free of charge to countries for use in preventing vertical transmission of HIV (infection of HIV from pregnant mothers to their children).

In the past, when only AZT was shown to be effective in vertical transmission in the United States, African advocates had to argue to reduce the costs of anti-HIV drugs for access in Africa. In the past few years, researchers have found other options in addition to AZT. For example, nevirapine, given as a single dose to a mother at the onset of labor and a single dose to the infant within 72 hours, can help reduce vertical transmission for about $4 a dose. Although research studies have highlighted that a single tablet of Viramune can significantly reduce the risk of transmission to a child, the South African government seems concerned about the effectiveness of nevirapine and the possibilities of women developing resistances to the drug. According to a recent Boston Globe article, fewer than 18,900 African babies have received Viramune since the beginning of the program. This may be due to the lack of support from the African governments.

South Africa's Treatment Action Campaign (TAC) and other international advocacy groups were frustrated that the South African government was hesitating to follow the example of Brazil or of non-governmental organizations that are taking the initiative to import generic drugs to provide access to affordable treatment for HIV/AIDS. In South Africa recently, AIDS activists sued the government for not importing nevirapine or other antivirals for treatment of HIV. The United Nations Special Session on HIV/AIDS in June allowed participating countries to set global targets and timetables on issues reflecting the importance in the HIV/AIDS epidemic. Included in the key goals of the "Global Response to Crisis" is the 20 percent reduction in the number of children born with HIV by the year 2005.

One of the major issues that Boehringer-Ingelheim seems to have faced with its program in Africa is that of working only with African governments instead of working with African communities. The "lack of HIV/AIDS counselors in clinics; insufficient numbers of testing kits to test HIV-positive expectant mothers; a lack of attention toward educating women in Africa; and, in many countries, a lack of political will to push costly AIDS programs" may be additional problems as reported in a recent Boston Globe article. The requirements for the drug access program include accessibility of HIV testing kits and counselors to administer the HIV test to expectant mothers, distribution of nevirapine information, and demonstration that the anti-HIV medicines will be given to those patients who need them. Boehringer has set up an application process that is open both to governments and to private nonprofit organizations that run maternity programs within countries. The program has seen recent success in the Democratic Republic of Congo, Rwanda, Senegal, Uganda, Zambia, and Zimbabwe in Africa, and Guyana in the Caribbean.

Statistics provided from IAVI and UNAIDS. The UNAIDS Web site is unaids.org and UNAIDS can be reached at: unaids@unaids.org. For additional updates on AIDS access in Africa, consult the Web sites http://www.tac.org.za and http://www.globaltreatmentaccess.org.

Sources

1. United Nations, "Global Crisis/Global Action," United Nations Special Session on HIV/AIDS, June 25-27, 2001.

2. "African Nations Widen Medical Help to Women With HIV." The New York Times, September 1, 2001.

3. John Donnelly, "In Africa, Free HIV Drug Slow to Reach Babies at Risk -- Shortcomings Cited in Health Network." Boston Globe, September 7, 2001.

4. "HIVNET 012 Study Evaluates Viramune (Nevirapine) for Reduction of Mother-to-Child HIV Transmission in Africa." Boehringer-Ingelheim Pharmaceuticals (correspondance).