AIDS 2010 studies, releases: PMTCT, treating children, male circumcision; National prevention programs; IDUs

Jul 22 2010

"In parts of Africa, only about half of babies born to mothers with HIV receive the HIV prevention drug nevirapine," according to a study published Wednesday, HealthDay News/U.S. News & World Report reports.

The study, which was part of an HIV/AIDS theme issue in the Journal of the American Medical Association (JAMA) to coincide with the International AIDS Conference-AIDS 2010, "highlights the need to expand global programs designed to prevent HIV/AIDS in newborns. It also points to the need to incorporate ongoing monitoring and quality improvements into all nevirapine-based care programs, the study authors [led by researchers at the University of Alabama at Birmingham] concluded," the news service writes (7/20).

For the study, researchers analyzed the "cord samples from 27,893 mother-infant pairs treated at [43 separate] clinics in the African countries of Cameroon, Cote d'Ivoire, South Africa and Zambia," where "single-dose nevirapine is used to prevent mother-to-child transmission, along with additional prophylaxis drugs," according to a University of Alabama at Birmingham press release. The researchers then analyzed the cord blood nevirapine for 3,196 "HIV-seropositive mother-infant pairs," finding that "only 51 percent of HIV-exposed infants received the minimal regimen of nevirapine to protect them" (7/18). "The study also found that many HIV-positive women who were prescribed nevirapine before giving birth had no sign of the drug in samples of their umbilical cord blood," Health Day News/U.S. News & World Report adds (7/21).

"...[F]ewer antenatal visits and younger maternal age were both strongly associated with failure to receive prophylaxis," the authors reported in the study. "[S]uccessful prevention of mother-to-child HIV transmission requires each mother-infant pair to negotiate a critical path that begins with the offering of an HIV test and proceeds through post-test counseling to drug adherence and beyond," the study authors write. "Our findings indicate that programmatic failures are common along this path, and that each clinic faces its own mix of challenges in maximizing service coverage."

Though the authors praised the WHO's decision in 2009 to revise "its international guidelines [.pdf] that made more efficacious (and complex) drug regimens to prevent mother-to-child HIV transmission standard," as "a critical move toward global pediatric AIDS control," they also noted, "it holds only half the key. The other half lies in service coverage. Even the most potent interventions will not protect those infants who do not receive them" (Stringer et al., 7/21).

WHO Recommendations For PMTCT Of HIV, Starting Children On HIV Drugs Earlier

The WHO on Tuesday "issued new guidelines aimed at strengthening efforts to prevent pregnant women from transmitting the AIDS virus to their babies and improving care for infants who are born with the infection," the Wall Street Journal reports. "The recommendations call for earlier HIV testing for women after they become pregnant and earlier treatment with antiretroviral drugs for both their own health and to halt transmission to their newborns." The newspaper notes a key goal of UNAIDS is to eliminate the mother-to-child transmission of HIV by 2015 (Winslow, 7/21).

"The child's health is inextricably linked with the health of its mother," Gottfried Hirnschall, WHO Director of HIV/AIDS, said in a WHO statement. "Ensuring HIV-positive mothers have access to treatment for their own health will greatly improve outcomes for their children" (7/20).

Los Angeles Times's "Booster Shots" blog: "An estimated 400,000 infants acquire HIV each year, primarily at birth but also from breastfeeding, the agency said. Without early diagnosis and treatment, about one-third of them will die by their first birthday and about half by their second. While the WHO noted the [t]reatment of HIV-positive children in the developing world grew by 28% in 2009, from 276,000 in 2008 to 365,000, … many children are still going untreated" (Maugh, 7/20).

USA Today: "Many children younger than a year old lack access to HIV treatment, because HIV tests are unavailable in some places. As a result, the WHO is calling for greater access to infant diagnosis starting at four to six weeks after birth" (Sternberg, 7/19).

"With early diagnosis and prompt treatment, children have far better chances of surviving," Hirnschall said in the WHO statement (7/20).

"In addition to urging more-aggressive testing and treatment, the guidelines say that as long as either the mother or the child is on antiretroviral drugs, it is safe for women to breast-feed their babies, an issue that has been a source of controversy," the Wall Street Journal continues. "Hirnschall said the very small risk of transmission is more than offset by the often life-saving nutritional benefits of breast-feeding," the newspaper adds.

"Paul De Lay, deputy executive director of programs at UNAIDS, estimated that the new guidelines, by expanding the use of drugs and some services, will roughly double the annual cost of reaching women who need the medicines to between $1.2 billion and $1.5 billion," the Wall Street Journal adds. "Hirnschall said the new guidelines would also require additional training of medical staff in developing countries to administer  [HIV treatments] properly" (7/21).

The article includes comments by Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, Jimmy Kolker, chief of HIV and AIDS for UNICEF, and Christoph Benn, director of external relations at the Global Fund to Fight AIDS, Tuberculosis and Malaria (7/21).

By Increasing Male Circumcision Rates By 80% In Eastern, Southern Africa, Could Drive Down Number Of New HIV Infections By 4M By 2025, Researchers Say

"More than 4 million new HIV infections could be prevented in eastern and southern Africa by 2025 if male circumcision rates were increased to 80 percent, researchers said on Tuesday," Reuters reports. "Expanding circumcision services to 80 percent of adult and newborn males in the region would also save $20.2 billion in HIV-related health costs between 2009 and 2025, they said" (Kelland, 7/20).

"Sub-Saharan Africa accounts for about two-thirds of the more than 33 million HIV-positive people worldwide, with an estimated 1.9 million people in the region newly infected each year," the Los Angeles Times' "Booster Shots" blog adds. "Studies sponsored by the World Health Organization have shown that circumcision reduces the risk of HIV infections in men by 60%, although results so far show no benefit for blocking transmission to women" (Maugh, 7/20).

During the conference Tuesday, the health aid group Population Services International (PSI) "presented results of a study from Zimbabwe, where researchers designed and tried out an efficiency model called MOVE, aimed at increasing the numbers of male circumcisions by using better techniques, training, equipment and staff," Reuters adds. "In a pilot of the new system, a team of two doctors and three nurses was able to carry out four circumcisions at the same time and increase their rate from three operations per hour to 10, the results showed. Over 12 months of the pilot, around 6,500 men were circumcised."

According to PSI, the MOVE model does not compromise the quality of the procedure received nor did it cause and increase in the percentage of patients reporting side effects from the procedure (7/20).

While the MOVE model increases efficiency, in order for health experts in Zimbabwe to reach their goal to circumcise 80 percent of the young men in the country, they will "need to embark on an education and information campaign," explained Karin Hatzold, senior director of HIV services for PSI in Zimbabwe, according to the Guardian.

"Krishma Jafa, PSI's HIV, TB and reproductive health global director, said she hoped the rapid circumcision model would prove useful in many other countries - there are 13 countries in southern and eastern Africa where under 10% of men are circumcised and HIV rates are high," the newspaper writes. "We are in discussions in Zambia, demonstrating to them that it is a viable route to take," she said (Boseley, 7/20).

Bloomberg reports on the most recent statistics on the numbers of men who sought circumcisions in Kenya. "More than 90,000 men have been circumcised in Kenya since October 2008, including 36,000 over 30 working days late last year, researchers from the African nation said" during AIDS 2010 Tuesday. "Kenya, where about 8.5 percent of people are infected with the AIDS-causing virus, plans to circumcise 80 percent of uncircumcised men age 15 to 49 to prevent more than 100,000 HIV infections over the next 10 years," the news service writes (Bennett, 7/20).

Most National HIV Prevention Programs Don't Focus On Local Needs, Report Says

Just 10 percent of countries have HIV prevention programs that address national needs, according to a report card (.pdf), released Tuesday at AIDS 2010, by the Global HIV Prevention Working Group, which consists of 50 leading experts, Reuters reports.

The group "said many effective HIV prevention steps are not having anything like the impact they could because they are often not available to those at the greatest risk of infection," the news service writes.

"The working group graded the efforts of various sectors - including national government, international donors, and global health agencies - and said none had earned good grades," Reuters writes. Among some of the findings, the report card noted that in countries in sub-Saharan Africa with "population wide epidemics," only 45 percent of HIV-positive pregnant women get the necessary drugs to prevent them from passing the virus on to their babies.

Helene Gayle, co-chair of the Working Group and chief executive of CARE USA said, "Our overall finding is not that prevention is failing, but that we are failing prevention" (Kelland, 7/20).

"The report card - which assesses the quality of global HIV prevention efforts against recommendations the Working Group has made over the past decade - also finds that many countries and donors have begun taking steps to strengthen HIV prevention programs, and urges that these efforts be accelerated," according to a press release (.pdf) from the group. The release includes recommendations for ensuring HIV resources are used effectively, like matching prevention strategies with local priorities, expanding cost-effective prevention tools, setting prevention goals and monitoring progress, creating policies to combat HIV discrimination and increasing funding for HIV prevention (7/20).

HIV Prevention Programs Are Missing IDUs, Studies Show

"Fewer than 10 percent of injecting drug users (IDUs) get practical help to prevent" the spread of HIV according to research released on Tuesday at AIDS 2010, Agence France-Presse reports in a piece that examines the results of a series of papers published online Tuesday in the Lancet.

"Injecting drug use takes place in 151 countries, with an estimated 11—21 million such users in 2007, of whom 0.8—6.6 million were estimated to be living with HIV," according to one of the Lancet papers.

Despite this, the authors of the paper report, "[c]urrent coverage of interventions for injecting drug use is inadequate; annually worldwide, perhaps 5% of drug injections are covered by a sterile needle and syringe provided by an NSP; eight clients receive OST for every 100 IDUs (range 6—12); and four IDUs receive ART for every 100 HIV-positive IDUs (range 2—18)" (Degenhardt et al., 7/20).

The AFP article highlights additional papers in the series that were presented at AIDS 2010. The topic of HIV transmission among IDUs has been a major focus at the conference (7/20).

All of the Kaiser Family Foundation's webcasts of select sessions from AIDS 2010 are available at www.kff.org/aids2010.