Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.
Bangkok Post - February 19, 1998
Aphaluck Bhatiasevi
The HIV/Aids Collaboration (a joint activity of the Ministry of Public Health and the US Centres for Disease Control and Prevention) announced that the 95 percent results of the short course study on use of AZT showed that the drug is 51 percent efficient in reducing perinatal HIV transmission.
Final results of the study are expected to be officially announced in April, said Tim Mastro, who headed the collaborative study in Thailand.
The Bangkok Perinatal AZT Study was conducted on 397 HIV positive pregnant women at Siriraj, Rajvithi and Children's hospitals in Bangkok, where more than two percent of pregnant women are HIV positive and more than 800 HIV positives deliver annually.
Under the short course study which began in May 1996, 198 HIV positive pregnant women were given 300 milligrammes of AZT twice a day from 36 weeks gestation until labour and 300 milligrammes every three hours from the onset of labour until delivery.
No AZT was given to infants, but they were provided with infant formulas.
The results of the study showed that of 198 persons who received AZT under the trial, the HIV transmission rate was 9.2 percent.
In comparison, the HIV transmission rate for those who received AZT under the Aids Clinical Trial Group (ACTG) 076 study was eight percent.
It costs about $800 to provide each mother-child with AZT, while the cost of the short course regimen is only $50, said Permanent Secretary of Health Prakrom Vuthiphong.
The ACTG 076 study, which showed that intake of 100 mg of AZT five times a day during the first 14-34 weeks of pregnancy, intravenously during labour and to the child for at least six weeks reduced HIV transmission from 25 to eight percent.
Although the ACTG 076 regimen is considered a standard treatment in the US and other industrialised countries, it is said to be too expensive and complicated to be carried out in developing countries, including Thailand, said Dr Prakrom.
In addition, he said most pregnant women in Thailand approach antenatal clinics during the late stage of pregnancy.
Dr Prakrom said government administrators will be asked to consider the matter and enforce it as a standard of treatment.
The study also showed a natural reduction in the rate of perinatal HIV transmission which was initially believed to be at 24 percent.
Among the 199 pregnant women given placebos, the transmission rate was 18.6 per cent, said Nathan Shaffer, an epidemiologist at HIV/Aids Collaboration.
Dr Shaffer said the study also confirmed that perinatal transmission occurs most just before and during delivery.
The announcement of the study would also bring an end to the use of placebos in other AZT trials, including the one in Cote d'Ivoire, according to Dr Shaffer.
The study had been heavily criticised by US-based NGOs for using placebos despite a known effective AZT treatment.
Dr Shaffer said that had placebos not been used for the trial, it would have not been known that there was a natural reduction in the rate of mother-child HIV transmission.
Dr Mastro said the US Centres for Disease Control and Prevention will provide AZT support to both Siriraj and Rajvithi hospitals so that HIV positive pregnant women are not deprived of the drugs just because of financial constraints.
There are more than 20,000 HIV positive pregnant women who deliver each year in Thailand.
Prior to these findings, the only regimen of proven effectiveness for perinatal HIV prevention was essentially out of reach for Thailand and most developing countries, where over 90 percent of HIV infections occur.
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