<b>HIV Transmission: Thai doctors score big</b>

Arthit Khwankhom - The Nation

Siriraj hospital yesterday revealed dramatic success in reducing the HIV transmission rate from mother to child - to less than 3 per cent.

Doctors treated mothers with high doses of anti-retroviral drugs a few weeks before they gave birth, at a cost of just Bt1,800 per month per person.

The previous rate of transmission using the standard treatment of AZT alone was 11.7 per cent, said Dr Piyasakol Sakolsatayatorn, dean of Siriraj's Faculty of Medicine.

The results are significant, as thousands of Thai children are believed to get HIV from their mothers every year.

In the new procedure, from the 34th week onward, mothers are treated with a combination of AZT (500mg) and 3TC (150mg) every 12 hours until the onset of labour. After that they are given the drugs every three hours until delivery.

To prevent virus transmission via mother's milk, breast-feeding is not permitted. Formula milk is the preferred alternative. During the first four weeks babies are also given AZT syrup every six hours.

3TC is believed to help reduce the resistance to treatment with AZT, said Dr Pongsakdi Chaisil-wattana, lead author of the study, who is also heads the hospital's gynaecologic endoscopy division.

The study of 109 cases was conducted over the past five years, he said, and was the largest sample trial ever undertaken.

"The sample was large enough to make sure the study results were reliable," he said.

Side-effects from the treatment were rare, and it does not cause nausea or headaches.

The Public Health Ministry is considering encouraging the procedure in state hospitals.

"Zero per cent is impossible," Pongsakdi said. The lowest rate of children infected with HIV from their mothers in the United States was 1 per cent, and that was by carrying out an early caesarean operation, in addition to using anti-retroviral drugs

.

This technique was very expensive, he said, and it would not be suitable to adopt it as not all hospitals are capable of carrying out the operation up to the required safety standards.

"For us, caesarean section is not a better choice since we cannot see any significant benefit from it when compared to the method we have studied," he said.

The onset of labour, and when mothers give birth are believed to be the most critical times for the virus transmission, so higher doses of the anti-retroviral drugs are given then.

Pongsakdi said blood tests taken at these times showed minimal amounts of the virus cells, which doctors say are almost undetectable. Therefore, there was no need for a caesarean and mothers could give birth naturally, he said.

For the next step, Siriraj, in conjunction with other organisations, plans to carry out a study on the use of a tri-regimen - using a combination of three types of anti-retroviral drugs - to reduce the infection rate even more by next year.

- The Nation -