South Africa: Treatment Action Campaign Gives Cautious Welcome to State's HIV Guidelines

South Africa's newly released guidelines for preventing mother-to-child HIV transmission include some improvements but still fall short of World Health Organization recommendations, the AIDS lobby group Treatment Action Campaign said Wednesday.

The new guidelines call for all HIV-positive pregnant women to be given dual therapy, consisting of a short course of AZT starting in the 28th week of pregnancy and a single dose of nevirapine during labor. Their infants will receive a dose of nevirapine syrup and seven days of AZT, which is more effective than nevirapine on its own -- currently the standard treatment in all provinces except Western Cape, which introduced dual therapy three years ago.

In addition, the guidelines recommend routine HIV testing for all pregnant women visiting antenatal clinics. Babies born to HIV-positive mothers will be screened for the virus at six weeks and at 18 months.

But the guidelines do not change the threshold for initiating long-term therapy, calling for treatment of HIV-positive pregnant women to begin only when their CD4 counts fall below 200, not 350 as activists have urged. TAC expressed disappointment at this decision, noting the health department's own expert committee endorsed the 350 treatment threshold.

The guidelines also do not include using extra drugs to minimize the mother's risk of nevirapine resistance, as proposed by WHO in 2006. TAC noted that Health Minister Manto Tshabalala-Msimang often expressed concern about nevirapine resistance among pregnant women. Her decision not to include a post-delivery, week-long course of AZT and lamivudine "made little sense," TAC said, noting this strategy was "strongly recommended" by HIV pediatricians advising the health department.

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