South African health officials say the key anti-AIDS drug Nevirapine may not be used in government hospitals unless it is given in combination with other drugs. The drug is currently prescribed to prevent mother-to-child transmission of HIV/AIDS. AIDS activists in South Africa are critical of the decision, because they say Nevirapine used alone is still better than giving AIDS patients nothing at all.
The Medicines Control Council, which regulates prescription drugs in South Africa, says giving Nevirapine by itself to mothers in labor could create a strain of AIDS that is resistant to the drug. As a result, the Council wants it administered only in combination with another drug.
The Council cites a new study that found that use of Nevirapine on its own led to significant resistance in up to half of all patients. That could affect a mother's ability to use the drug later as part of her own AIDS treatment program.
The new recommendation has prompted concern from several quarters, including from the authors of the study itself and from the vocal AIDS activist group, the Treatment Action Campaign. Campaign spokesman Nathan Geffen says the group does not object to the change in policy itself, just to the way it was announced.
"We think the change in protocol that's being recommended by the medicines control council is something we would welcome....," he said. "It will be more effective and will help the resistance problem. But what's also important is that clinics and hospitals around the country that are currently providing the single-dose Nevirapine should not be stopped from doing so. What they should be given is the resources they need to upgrade their program to the multiple-drug regimens, the combination drug regimens, as soon as they can. But in the meanwhile, they must continue with their programs."
The Treatment Action Campaign sued the government in 2002 to force it to provide mother-to-child-transmission treatment. The nationwide Nevirapine program is a legacy of that court case.
The most controversial aspect of the Nevirapine policy change comes not from the Medicines Control Council statement, but from remarks made by Health Minister Manto Tshabalala-Msimang at the AIDS conference in Bangkok on Monday. She implied that the Treatment Action Campaign had forced the government to use an unsafe treatment, and appeared to be justifying the government's reluctance to implement the mother-to-child-transmission-prevention program by citing the results of the new Nevirapine study.
Mr. Geffen, however, says the health minister herself chose Nevirapine for the court-ordered program. And he maintains that even a flawed treatment is better than no treatment at all.
The issue of AIDS drugs has long been controversial in South Africa. The Treatment Action Campaign also used the courts to pressure the government into providing anti-retroviral therapy to AIDS patients in public hospitals - a regimen that the health minister argued was too expensive and possibly unsafe, despite its widespread use in other countries. South Africa has more HIV-positive people than any country in the world, with more than five million cases.