SAf News Agency 16 Nov. 1999

South Africa simply could not afford to give the anti-AIDS drug AZT to people with HIV and AIDS, Health Minister Manto Tshabalala-Msimang said on Tuesday.

Further advice and study were needed regarding the appropriateness of the drug, she said in a statement to the National Assembly.

At current market prices, the cost of administering AZT to the estimated four-million South Africans who are HIV-positive would be 10 times the country's total health-care budget, and 140 times what was spent on pharmaceuticals in the public sector.

She said AZT was initially developed for use in chemotherapy for cancer patients.

"It was, however, never used in cancer patients because it was regarded as too toxic to use.

"Tests have shown that rats that were exposed to high levels of AZT for prolonged periods of time developed vaginal cancer; this is a very serious finding," she said.

As health minister, she was responsible for ensuring that South Africans got appropriate and affordable health care.

"This responsibility extends to ensuring that no health care intervention has a long-term negative effect on people.

"With the evidence before me, I believe that the proper thing to do is to invite both the South African Medicines Control Council and a group of independent scientists, approved by Southern African Development Community health ministers, to review the use of AZT, and to inform me and other SADC health ministers of their position."

Tshabalala-Msimang referred to various trials on the efficacy of AZT in preventing the transmission of HIV from pregnant mothers to their babies, as well as one jointly done by the United States and Uganda involving a new drug, Nivirapine.

The latter proved to be markedly more effective than AZT. It was also safer, less expensive and more practical than AZT, or any other drugs tested so far. However, resistance to Nivirapine seemed to develop faster than to AZT. Studies were being done in South Africa to compare Nivirapine to a short course of AZT, and to a course of AZT plus another retroviral drug, 3TC. The findings, expected in March next year, would provide critical information on mother-to-child transmission of HIV in South Africa.

"Until then, we simply do not have enough information, either on the affordability... or the appropriateness of the drugs to make any decisions that might have long-term health effects on the lives of children born to HIV positive mothers."

One problems was that the virus could be transmitted through breastfeeding. In South Africa, substitutes for breast milk were not affordable to many women, and many also had no reliable source of clean water to use for the mixture, or to sterilise bottles.

Also, the toxic effects of the drugs in babies were doubled because they got their own dose of the drug and a dose from their mothers during labour and delivery. Only a quarter of HIV-positive mothers passed the virus on to their babies.

Tshabalala-Msimang said South Africa was the only country where AZT was registered to treat health care workers following needle-stick injuries. However, as far as she knew, AZT was not registered in South Africa or anywhere else in the world for use by women who were raped by men with HIV or AIDS.

"We have absolutely no idea of what the effects are, either short-term or long-term, of using AZT, a known carcinogen, on healthy people. The use of AZT is, at the present time, illegal, aside from it being dangerous."

Tshabalala-Msimang said South Africa's plans to investigate the development of a vaccine for HIV and AIDS were well advanced. The Medical Research Council would undertake this process.

She said she had also instructed her department to develop guidelines for the prevention and treatment of opportunistic infections, such as diarrhoea, pneumonia and other HIV-related diseases.

In an effort to make sure the government got medicines for at appropriate market prices, she had instructed her department to compare the prices of local medicines with those in other countries, and to report back urgently. "In addition... the World Health Organisation's regional office for Africa has initiated a pilot scheme for dealing with the treatment of opportunistic infections in a home-based care situation, and South Africa is one of the 15 Southern African countries that is benefiting from the scheme," Tshabalala-Msimang said.