Mother-Child HIV Infection Threatens Africa's Future

Dakar- Senegal (PANA) -- Nkosi Johnson, the 12-year old South African anti-AIDS activist was laid to rest at the weekend after succumbing to the incurable acquired immunodeficiency syndrome.
The Cape Town boy, whose frail image hit the headlines and television screens since he fell into a comma last December, will be remembered for courageously speaking out against stigmatisation of people living with the HIV, which leads to the lethal disease.
"It is shameful that we adults cannot protect children like Nkosi from getting this terrifying disease," remarked a senior Senegalese journalist with sorrow, after seeing one of the TV pictures of Nkosi on his deathbead.
Nkosi inherited the human immundeficiency virus from his mother who died of AIDS when her infant was just two years old.
"Imagine how many of such children are being born to HIV- infected mothers or getting the virus through breast-feeding which is common in Africa! "While the huge external debt will constitute one of the main economic challenges of the African Union, the fact that many infants are being born with HIV will be its main health challenge," said a Dakar-based gynaecologist/obstetrician from the Great Lakes region.
He cited the fact that a majority of the estimated 25.
3 million sub-Sahara residents currently living with HIV are young women "in the procreation age.
" According to the President of the Medical Research Council of South Africa, Prof.
Malegapuru Makgoba, his country has between 4.
7 million to 5.
3 million people living with HIV or AIDS.
"About 35 percent of HIV-infected mothers in South Africa who are not receiving (antiretroviral) treatment will pass the virus to their newborns," said Makgoba in a recent lecture at the National Institute of Health in Bethesda, Maryland.
The situation could be more serious in war-ravaged African zones, including the Great Lakes region, Sierra Leone and elswehere.
Nkosi's death occurred amid growing international pressure on multinational pharmaceutical companies to lower prices of anti-retroviral therapy, which helps to prolong the lives of rich HIV patients in developed countries.
The drugs cost about 20,000 dollars per year.
Although several African countries have reached bilateral agreements to obtain these drug at a cheaper rate, anti- retroviral therapy is stil far beyond the reach of Africans living with HIV.
UN Secretary-General Kofi Annan in April launched in Abuja, Nigeria, an initiative to raise 10 billion dollars per year to finance anti-AIDS activities.
Recognising the fact that AIDS needs to be combated in Africa where it is more prevalent than in other continents, the US administration pledged 200 million dollars to launch the fund raising.
Melvin Foote, President of the Washington-based Constituency for Africa (CFA) thought that the superpower could have pledged more funds so as to encouarage other rich countries to follow suit.
The CFA is a non-governemtal organisation of African Americans that champions African causes in the US.
Recognising the gravity of HIV/AIDS in Africa, European Union authorities have also requested multinational pharmaceutical companies to apply lower prices when selling antiretrovirals to poor African states.
But, amid this clamour for antiretrovirals, medical authorities in the US as well as in poor countries are also expressing concern that the rapidly evolving HIV has shown ability to resist the drugs.
There are about 15 drugs which are used to reduce the viral load within the blood system and hold at bay the capacity of the virus to damage the body's immune system.
Antiretrovirals are grouped into three classes, namely nucleoside reverse transcriptase inhibitors or NRTIs, non nucleoside reverse transcriptase inhibitor (NNRTIs) and protase inhibitors (PIs).
The lack of options to treat individuals living with drug resistant HIV is the main dilemma facing researchers at the Havard AIDS Institute in Boston, Massachusetts.
"Cross-resistance is really our biggest problem.
Even though there are a number of drugs out there, we often find that when one drug fails, the virus is actually resistant to several drugs within the same class," says Dr Richard D'Aquila of Massachusetts general hospital.
According to the 2001 winter/spring issue of the 'Havard AIDS review', HIV becomes resistant to medications because of the high rate at which it mutates.
"The single most important thing a patient can do to avoid drug resistance is to be faithful to his or her drug regimen," adds D'Aquila.
However, many people discontinue their drug treatment because of their intolerable side effects of the 25 drugs a patient has to swallow each day.
A person living with HIV must take antiretrovirals for a lifetime.
Some HIV patients abandon the antiretrovirals as soon as they start feeling well again while others cannot afford to continue paying for the life-prolonging drugs.
Antiretrovial threrapy is a life-long affair and the Havard AIDS Institute has warned that " drug resistant strains will spread as more people take antiretrovirals without achieving full viral suppression.
" It cited a January 2000 study in Canada which showed that nearly 10 percent of 81 newly infected individuals were living with viral strains resistant to multiple drugs.
Another study in the US military found 20 percent of strains resistant to NNRTIs, the publication says, adding that approximately 90 percent of the estimated 36.
1 million people living with HIV in the world "do not have access to powerful drug combinations to prevent drug resistance by keeping viral replication low.
" "People living in resource poor countries may only be able to afford less powerful drugs, and only occasionally, regimens that may actually increase their risk of developing drug resistant HIV and of transmitting it to others," cautions the Harvard AIDS review.
Even if the prices of antiretrovirals is reduced, not many Africans would have access to them due to the poor state of health infrastructures, including well-equipped virological laboratories.
Besides emerging drug-resistance, the co-infection of persons with different HIV strains is also a major concern of researchers at the Harvard AIDS Institute.
Investigations on the hybrid HIV-1 and HIV-2 strains known as "recombinant" viruses "has made the development of medical interventions much more difficult," says the institute's publication.
Rosemary Musonda, who heads the Immunology Unit at the Ndola Tropical Diseases Centre in Zambia is quoted as saying: "Our concern is that if drug prices are not brought down enough, there will be more people on monotherapy.
"These drugs may be taken in inadequate amounts, and that can produce drug resistance.
" In a globalised world, the presence of HIV resistance not only constitutes a threat to the population in Africa but the entire international community, hence the need to continue efforts to prevent its further spread.
Among other things, Nkosi's death evokes a feeling of guilt on the entire African and world community for failing to prevent the runaway virus.
How to deal with the thousands of infants born with HIV or have been orphaned by the incurable disease that had already killed 17 million Africans by the end of 2000 will be one of the AU's major challenges.

11 june 2001 14:45:00

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