The national Essential Drugs List (EDL) committee has recommended that the health department should change its guidelines for treating babies born with HIV and start them on antiretroviral therapy as soon as possible.
If the recommendation is accepted and the policy implemented, thousands of babies' lives could be saved each year.
The EDL committee's decision follows a landmark South African study, published in the New England Journal of Medicine this week, which showed that treating newborn HIV-positive babies straight away instead of waiting until they fell sick cut the death rate by 76%.
Preliminary findings from the Children with HIV Early Antiretroviral Therapy (Cher) study were released at an international AIDS conference in Sydney last July and presented to the health department last November.
The World Health Organisation, the US and Europe have already changed their guidelines to incorporate the study, but it is understood that South African officials decided to wait for the research to be subjected to peer review - now done by the influential and respected New England Journal of Medicine - before taking a decision.
Current South African guidelines say infants with HIV should only be given antiretroviral medicines if their CD4 count (a measure of the strength of their immune system) falls significantly, or if they develop AIDS-associated illnesses. The babies are given a cocktail of three drugs - kaletra, 3TC and zidovudine or stavudine.
Two independent sources yesterday told Business Day that the EDL committee met last week and unanimously agreed that SA's guidelines for treating babies with HIV should be changed in the wake of the Cher study.
It is understood that the issue will be discussed next week by the National Health Council, which includes provincial health MEC and is chaired by Health Minister Barbara Hogan.
The powerful EDL committee advises the health department on which drugs to provide to public hospitals and clinics, and specifies how the medicines should be used. Its decisions have to be signed off by the health minister before they can be put into practice by the provinces.
The Cher study, which included 377 infants in Cape Town and Johannesburg, found only 4% of babies died if they got treatment right away, compared to 16% if therapy was withheld until there were signs of illness or their CD4 levels had fallen.
Study co-author Prof Mark Cotton from the University of Stellenbosch estimated that 11000 babies had died from HIV-related causes before they reached their first birthday in the past year.
Most of them could have been saved if they had been diagnosed soon after birth and started on treatment right away, he said. "The clock is ticking," he said.
Cotton conceded that changing policy on treating infants would have cost implications, but said it was cheaper to treat babies than admit them to hospital with AIDS-associated illness. Testing newborn babies for HIV was expensive, but there had been significant improvement in the availability of tests at clinics over the past year, he said.
"It's amazing that SA has led this research, and it will be even more amazing if we can implement its (findings)," said Dr Ashraf Coovadia, a specialist HIV pediatrician and adviser to the South African National AIDS Council.
Source: AllAfrica.com, 21 November 2008