Statement of Cathy Wilfert, Scientific Director, Pediatric AIDS Foundation

. 0/06/1997 12:32 9199680447 WILFERT
9-22-1997 1 0: 48AM FROM PEDIATRIC AIDS 3 1 393 1882

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Pedia tr Ic
For Immnediate Release
September 17, 1997

AIDS
Contact

Foun d at io n
Cheryl Cocdk
Pediatric AIDS Foundation
310/395-9051

i AIDS

BOARD OF DIR C1ORSi
C#W4JRPEMSON
Paul M. Oiasef
Peter 5enzlan
6cD Bwnt
Marlene Canter
Susan DeLaurenti s
Philip A. Pltzo. M.D.
Susie Zaegen
Uloyd S. ZMiderman
Eizabeth Glaser
VCRCUTIVE ADVISORY BOARD
IfOtfQR rcofAIA
Presi lent and Mr. Ronald Reagan
Mrs. Wiian 2, Black
Aifred A.C C~chI
9(thiyn 0. Checchi
t Duii
Wlhel 0. Vmner
Su~*Pd
Senator Paula Hateis
Ellen Joam
MktaeS. Oiti
Steves Spem
Jonathan M. Tesh
Aleaan r Vrysiund
Mrs. Fete ilson
frCALTH ADVISORY OARD)
CKAIRPU#SON
Cath~rrn* iM. WrtM. A.
Y..itne J.Oryso. M.D.
Murk F@:IWo. MOD.. Ph.D.
MC wS. G +,MD.
Margar t C..gaar c. M.D.
David 0- ii,. M.D.
Ann.a5*110 i (Ogftn. MFA. MAC
DenleI V. t.*ndera. M.V.
M~snasi McCune. M.D..- Ph.D.
Jm s0lwlia. MD.. M.P.M.
Glra S. Pac chsm, MD
Ptu4p A- Pto. M.D.
tnoo* NA.5.DSot.D.. vR"....s t0hm 0..At/r ~"~ w

Statement of Cathy Wilfert
Scientific Dir~ector, Pediatric AIDS Foundation
Response to the September 17 New England Journal of Medicine
Editorial and Sounding Board
In 1994, a clinical trial (ACTG 076) showed that AZT administered to
pregnant women during pregnancy, labor, and delivery and to their babies
dramatically reduced maenl-to-lnfant tranmission of 11WV. In the U.S. this
has now diminished the number of HIV-infected infants born. Nationwide,
it is estimated transmission may have been reduced from approximately 2,00
infants per year to 500 infants per year. This has been achieved over more
than three years and we can do even better. It is now the standard of care in
the U.S. to offer counseling and testing to all pregnant women and to offer
antiretroviral therapy to all l{I-lnfected women. In the U.S. and any nation
where AZT or other arntietroviral therapy is accessible it is wrong to fail to
offer therapy to HV-infected pregnant women. Trials studying peririatal
intervention cannot ever again utilize a placebo in the U.S. It has already
been forgotten that when the ACTG 076 trial was designed, vehement
objections were raised because the study was specifically designed to stop
mother to infant transmission of virus. The trial was termed unethical
because it was not designed specifically to treat women. The mothers
received state-of-the-art AZT therapy which was not routinely continued after
the baby was born based on existing recommendation for treatment at that
time. Objections were raised to giving precedence to prevention of infection
in the infant and the trial was delayed for many months by this debate.
In developing nations where 1000 Infants are infected each day
there has been no change in maternalto-infant transmission rates of IV. In
these developing nations including sub-Saharan Africa and
Thailand, women often lack access to prenatal care and many deliver
their infants at home. The cost of the 076-AZT treatment (estimated to be.
$1,000) exceeds by many fold the per person annual total health expenditures
(less than $10 per person/year). Antiretroviral therapy is unfortunately not
available in these countries. Health care providers in developing nations are
aware of the 076-AZT success and desperately want an effective intervention
they can implement in circumstances which are very different from those in
the U.S.
In 1994 the World Health Organization convened a meeting with