Cost-Effective Treatment Possible In Africa For HIV-Positive Pregnant Women If Drug Prices Lowered

May 08, 1998

Reducing the high rate of mother-to-child HIV transmission in Sub-Saharan Africa through treatment with antiviral drugs can be cost-effective if drug prices are lowered, according to a new study by researchers at the University of California San Francisco AIDS Research Institute (ARI).

Study findings showed other factors combined to produce a cost-effective outcome--such as a short-course of drug therapy and a high prevalence of HIV-positive women of child-bearing age--but drug prices had the most impact. The UCSF team found drug costs need to be about 25 percent of current prices in the industrialized world.

The UCSF team conducted an economic analysis of different treatment regimens of antiviral drug combinations among women in Sub-Saharan Africa. The regimens currently are part of UNAIDS-sponsored clinical trials in Africa that are directed at determining effectiveness in preventing mother-to-child HIV transmission, which AIDS specialists also call vertical transmission.

"The goal in our research was to determine under what circumstances, if any, this might be a good investment compared with other uses of funds for HIV prevention in low-income countries," said Elliot Marseille, DrPH, MPP, UCSF senior research associate and lead investigator of the study.

"When we did this study, we had to make educated guesses about how effective this therapy is likely to be. In the meantime, results from the Centers for Disease Control and Prevention-sponsored trial in Thailand have shown that a short-course of the antiviral drug AZT alone can cut vertical transmission by about half," he added.

Glaxo Wellcome also has announced its plan to reduce AZT prices for vertical transmission prevention in low-income countries to about 25 percent of industrial world prices, according to Marseille. "These events open the way for large-scale drug interventions because we now know that these therapies can make both medical and economic sense," he said.

The research findings are reported in the May issue of AIDS. Co-investigators are James G. Kahn, MD, MPH, UCSF associate professor of health policy and epidemiology, and Joseph Saba, MD, clinical research specialist, UNAIDS. It is estimated that about 6 million women in Sub-Saharan Africa-- which includes the countries of South Africa, Uganda, and Tanzania among others--are HIV positive. The prevalence of infection among child-bearing-age women exceeds 30 percent in many urban areas and 14 percent in rural regions.

In the UCSF study, researchers evaluated the economics of combination therapy using the AIDS antiviral drugs AZT and 3TC. The team compared the results of no treatment, which is the current practice in most of the developing world, with three regimens:

Among the study findings:

In previous studies in the U.S., the AIDS Clinical Trial Group of the National Institutes of Health found treatment with AZT beginning at the 28th week of pregnancy reduced vertical transmission by about two thirds, according to Diane Wara, MD, UCSF professor of pediatrics who has done extensive work in this area.

"While this protocol has great implications for efforts to stem vertical transmission, it is not practical in Sub-Saharan regions because women normally do not seek prenatal care this early in the pregnancy and this long course of therapy is too costly for the limited resources of the region," Marseille said.

According to co-investigator Kahn, the UCSF analysis "demonstrates that the interventions initially tested in the U.S. and other wealthy countries can lead to affordable public health strategies in poorer countries." But several steps must occur, he noted, for this to happen: shorter therapy and other changes to minimize resource use; careful evaluation of treatment efficacy of modified therapies; and reduction of high cost components, which in this case is drug price.

Directed by Thomas J. Coates, PhD, who also is a UCSF professor of medicine, epidemiology and biostatistics, the UCSF ARI is an institute without walls that encompasses all UCSF AIDS programs under a single umbrella. The ARI includes a dozen research institutes, a wide range of clinical, behavioral science, and policy programs, and close to 1,000 investigators.

University of California - San Francisco

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to