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Drug Ends Spread of AIDS From Mom to Child

Rating

3 Star

Drug Ends Spread of AIDS From Mom to Child

Our Review Summary

This story is about nevirapine, a drug of choice for the prevention of HIV transmission from mother to child during labor and delivery. Nevirapine crosses the placenta, and studies such as those cited in this story show that taking nevirapine decreases the chance of passing HIV to a child during labor. The story failed to mention that liver toxicity and skin reactions have been observed with long term use of nevirapine in combination with other HIV drugs. If proponents of the drug say it cuts the rate of transmission in half (though no data is provided in the article), that is still not an “end to the spread of AIDS from mom to child,” as the headline suggests. The story should have included the baseline risk of transmission instead of saying the drug “cuts risk in half.” Half of what? The point of the article is that the transmission rates with and without exposure to drug during prior pregnancy are not the same (14.6 vs 17.6%). The problem here is that we don’t have an explicit transmission rate for comparison; the literature says it was 25 to 40% in Africa before antiretroviral therapy. Thus rates of both 14.6% and 17.6% would represent a significant reduction in transmission. While there is no mention of the cost of this drug, it is labeled “inexpensive” and cost is an explicit consideration for resource limited countries. A cost comparison of preventative nevirapine vs. treatment of an infant born with HIV/AIDS would be interesting to note.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

No mention of the cost of this drug, though it is labeled “inexpensive”. Inexpensive is relative and may not be viable for health centers w/out funding from clinical trials. However, there is explicit consideration of cost for resource-limited countries.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

Some quantitative benefits of treatment provided, but it would have been better if the story provided a statement of baseline risk of transmission instead of “cuts risk in half.” However the point of the article is that the transmission rates with and without exposure to drug during prior pregnancy are the same (14.6 vs 17.6%). The problem here is that we don’t have an explicit transmission rate for comparison. The literature says it was 25 to 40% in Africa before antiretroviral therapy. Thus rates of both 14.6% and 17.6% would represent a significant reduction in transmission.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Nevirapine crosses the placenta. Studies in pregnant women have shown that nevirapine decreases the chance of passing HIV to a child during labor and at birth. Liver toxicity has been observed with long term use of nevirapine in combination with other HIV drugs, though this is not mentioned in the article. Additionally, other studies have shown 20-40% resistance to the drug after taking one dose as a protective measure in labor, yet there is no mention of the rate of resistance in the main study discussed in the article. Nevirapine may be “easy to take”, but quantification of side effects noted in this and other studies discussed is omitted. Given there is only a 3% absolute reduction in transmission in one study cited, the risks of the drug for newborns and their mothers needs to be discussed.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

No mention of trial design. Some results given, but they are incomplete.

Does the story commit disease-mongering?

Satisfactory

No evidence of disease mongering, though it would have helped if the story provided prevalence rates of HIV/AIDS in babies born to Ugandan women.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Sources do not appear to have conflicts of interest, and none are noted. The CDC and VP of Pediatric AIDS Foundation seem to be balanced sources without ties to pharmaceutical companies. How the nevirapine studies are funded would be good to note.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

No mention of other drugs that may have a similar effect. No mention of harms or disadvantages of taking the drug, even as a single-dose. Skin problems have been reported in people taking nevirapine in combination with other HIV drugs. Liver toxicity has also been reported, but only with long-term use.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Availability is clear from the statement that nevirapine “has become a mainstay in the effort to prevent mother-to-child HIV transmission in poor countries”.

Does the story establish the true novelty of the approach?

Satisfactory

The story makes clear that this drug has been around and been under study for some time. Prophylactic use in reducing mother to child HIV transmission is not new and has been established as effective in clinical trials.

Does the story appear to rely solely or largely on a news release?

Satisfactory

There is no evidence that this story relied solely or largely on a news release.

Total Score: 6 of 10 Satisfactory

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