Cape Town

Officials of a US foundation that has raised $1 million to prevent paediatric AIDS in Africa are expressing concern at a statement from the health ministers of Southern African countries raising questions about the use of the anti-retroviral agent AZT and the cheaper alternative nevirapine.

The California-based Elizabeth Glaser Paediatric Trust has earmarked $1 million for paediatric AIDS prevention in Africa using nevirapine, which is less expensive than AZT and simpler to administer. A single dose to mothers at the onset of labour, and a single dose to the baby in its first three days of life, cost less than $4 per treatment.

But this initiative could suffer as the result of a joint statement issued by the health ministers of South Africa, Botswana, Zambia, Namibia, Mozambique, Swaziland, Lesotho, Zimbabwe, Malawi, Tanzania, Angola and Rwanda at a meeting in Johannesburg this month held to discuss a coordinated response on HIV/AIDS.

The ministers acknowledged that administering either drug can approximately halve the numbers of HIV-positive children born to mothers who are HIV positive.

But they expressed “grave concern over possible side effects as a result of their toxicity and the potential development of resistance to these compounds”. They felt it was necessary to research the effects of “unnecessary exposure of children and mothers to these drugs”.

This action is understood to have been heavily influenced by the South African government's position (see Nature 402, 225; 1999). In South Africa, 22 per cent of women attending antenatal clinics, and seven per cent of new babies, are HIV infected.

Both AZT and the oral form of nevirapine are registered with South Africa's Medicines Control Council. But it is understood that the suspension form of nevirapine, which is administered to infants, has not yet been submitted to the council for registration.