Washington (H24N). Members of the Thailand branch of the Perinatal HIV Prevention Trial reported in the Oct. 5 issue of The New England Journal of Medicine that they have found a regimen of the anti-viral drug zidovudine that is inexpensive and prevents HIV-infected mothers from transmitting the virus to their unborn infants. The investigators were looking for treatments that could be used in developing countries where advanced medical equipment and large supplies of drugs were not available.

The regimen was modeled on Protocol 076, which was used by the Pediatric AIDS Clinical Trials Group (PACTG). In this protocol, pregnant women were given oral zidovudine for an average of 11 weeks before giving birth, and received zidovudine intravenously during labor. The newborns were given the drug for six weeks after birth and fed formula instead of breastfeeding. HIV transmission to unborn infants fell from 22.6 to 7.6 percent in the PACTG study, at a cost of $800 per mother/child pair. The Thailand group was looking for an equally effective regimen that cost less and could be used in rural areas where medical resources were limited.

They tried four different mother/child combinations of the drug, and the one that worked the best involved giving zidovudine to the mother from the seventh month of her pregnancy until she delivered, with a dose of nevirapine (a potent antiviral drug) as labor began, and a course of zidovudine for the infant for the three days after birth. The babies were not breastfed.

By modifying the dose, the researchers lowered the cost to $174 per mother/child pair, with equal effectiveness.

There were no significant side effects, and the infants did well on formula. The mothers, even in rural areas, took all the medication they were supposed to, and reliably took the extra dose as labor began at home. The infant mortality rate was low, and all 27 participating hospitals, even the ones in rural locations, were able to comply with the study procedures.

The researchers stressed that, since transmission during delivery accounts for most cases of HIV infection in the infants of women treated prenatally with a long regimen of zidovudine, the extra dose of nevirapine at the onset of labor was extremely beneficial.

Since only 25 percent of mother/infant transmissions of HIV occur before birth, and the other 75 percent occur through breastfeeding, much remains to be done in this field, but this step gives health-care workers in developing countries another tool in the fight against the worldwide scourge of AIDS.

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