LETTERS From CAMP Rehoboth |
Hopkins Study Seeks to Curb the Spread of HIV |
by Doug Rose |
As an HIV disease specialist at Johns Hopkins University School of Medicine, Brooks Jackson, M.D. has been working in Uganda for 11 years to research ways to prevent transmission of HIV from mother to child. In the course of his research, Dr. Jackson and his study team made a remarkable breakthrough. Now back in the United States, this research clinician is trying to find out more. "In Africa, total annual spending on health care is often less than 10 dollars per person," says Scott Barnett, Research Program Coordinator at Hopkins' Garey Lambert Research Center. "Low-cost approaches to HIV prevention are essential in such an environment." While in Africa, Dr. Jackson's study team was researching the effects of Roxane Pharmaceutical's Viramune (nevirapine), a relatively new non-nucleoside reverse transcriptase inhibitor (NNRTI), often used in combination with other drugs to fight HIV infection. In this clinical trial in Uganda, a single dose of nevirapine was given to HIV-positive pregnant women at onset of labor and a single small dose to the newborn within 72 hours of birth. The results were astounding. By using only two doses, the HIV transmission rate from mother to child was cut by nearly half. Retrovir (AZT) is the only other drug previously available with proven ability to prevent transmission of HIV from mother to child. In contrast to the nevirapine treatment, AZT requires the mother to take pills daily for at least a month, with a six-week regimen for the child following birth, and can cost more than $1000. Few Africans can afford such treatment. "For about $4 total per mother and child, nevirapine is able to substantially prevent HIV transmission from mother to child. This is a very important breakthrough for health care in developing countries and is projected to save 5 million babies from becoming HIV infected over the next 10 years if implemented throughout developing countries," says Barnett. "More babies could be saved from HIV in one year using nevirapine than the total number of patient admissions to Johns Hopkins Hospital over the last 10 years. This is extremely encouraging and shows that any drug capable of preventing transmission on any level is worth further exploration for preventing other types of HIV transmission." In order to learn more, Hopkins is currently recruiting HIV-negative individuals to participate in a study of the side effects and blood concentration levels of low dose nevirapine in HIV-negative persons at increased risk for HIV infection. The hope is that researchers might discover other low-cost ways to prevent HIV sexual transmission. "For example, if a woman in Thailand is forced into prostitution for a month in order to feed her family for a year, we might be able to reduce her risk of becoming HIV infected with a low-cost medication," says Barnett. "There might also be applications among those at risk for HIV infection in the U.S." Hopkins is currently seeking HIV-negative, sexually active gay men, HIV-negative partners in "discordant couples" (in which one partner is negative, the other is positive), sex workers, and others whose behaviors might be considered "risky." Volunteer participants receive a physical exam and are tested for HIV and hepatitis at no cost. "After the initial screening, we provide ongoing safer sex and risk reduction counseling during the study," says Barnett. "We absolutely do not want to encourage risky behaviors, and we want participants to have the best available education on how to protect themselves." Qualified participants begin a 12-week course of a very low dose regimen of nevirapine. During the medication period and several weeks after, participants meet with researchers and provide blood samples so that doctors can determine the side effects of the drug and the levels of nevirapine in the blood. The total time involves 9 visits over a 16-week period. "Nevirapine is generally well-tolerated with few side effects, especially at such a low dose," says Barnett. "And because there is no HIV present in the system, there is no risk for participants to develop 'drug resistance' unless they were to become HIV infected during the trial." For more information about the trial or to volunteer, contact Scott Barnett at 410-614-5820. Doug Rose is a member of Maryland's AIDS Legislative Committee. This article originally appeared in BGP and Mid-Atlantic Gay Life and is reprinted with permission. |
LETTERS From CAMP Rehoboth, Vol. 10, No. 6, June 2, 2000. |