Simplified ARV for MTCT

[Guest guest]

Hi,

Thanks for the mail. I would like to know more about

the program as the AIDS rate is being reduced so much.

Congratulations. Please give more details about study.

And also the recent study of mother-to-child

transmission through breastfeeding.

Jessy

E-maill jessica_george85@...>

[The following is in response to the request from .

Moderator]

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Simplified Antiretroviral Therapy During Pregnancy Effective and

Acceptable Among Thai Women, CDC Study Says

A Thailand Ministry of Public Health pilot program designed to test

and treat pregnant women for HIV with a simplified zidovudine regimen

reduced the risk of mother-to-child viral transmission from 30% to 10%,

CDC researchers reported in the July 20 issue of Morbidity and Mortality

Weekly Report. Routine prenatal counseling and voluntary HIV testing

were integrated into Thai public prenatal services by July 1998. As

part of a pilot program to determine if " simpler and more cost-effective

interventions " can prevent vertical transmission of HIV with the same

efficacy as the extended zidovudine prophylaxis used in wealthier

nations, HIV-positive Thai women were offered zidovudine from 36 weeks

gestation through labor and free infant formula for one year after birth

(Morbidity and Mortality Weekly Report, 7/20). Current U.S. guidelines

recommend beginning zidovudine treatment between 14 and 34 weeks gestation

and continuing through labor (Public Health Service Task Force

Perinatal HIV Guidelines, 5/4).

Results

Between July 1998 and June 2000, about 1% of 104,393 new prenatal

clinic patients tested HIV-positive, and at delivery 69% of 922

HIV-positive women had received zidovudine prophylaxis. Eight percent of 229

infants whose mothers had taken zidovudine were born with the virus,

compared to 14% of 64 infants born to mothers who did not use zidovudine.

Overall, the estimated vertical transmission rate was 10%. Researchers

noted that HIV testing, HIV results documentation and zidovudine use

" increased significantly " during the study period. To evaluate program

coverage, acceptability and influence, researchers interviewed two groups

of women: women who had given birth within two months of the interview

and whose delivery record did not include HIV status documentation and

those who had given birth within 12 months of the interview and were

documented to be HIV-positive. Of the 215 women whose HIV status was not

recorded at the time of delivery, 54% said they had an HIV test during

pregnancy, with 71% of the women tested reporting that they knew their

test result and those results were all negative. Of the 162

HIV-positive women, 94% knew they carried the virus before delivery, 98%

reported

having received post-test counseling and 79% had taken zidovudine to

reduce the risk of vertical transmission. Eighty-nine percent of women

taking the drug said they did not skip a single dose of medication and

only 1% refused to take the drug. All of the HIV-positive women said

they used the infant formula provided through the study, although 6%

noted that they breastfed for a " short period " of time. In comparison, 95%

of the women whose HIV status was not recorded at delivery reported

breastfeeding their infants.

HIV Prevention Potential

In an editorial note, the CDC says that the program interventions were

" acceptable to most women " and that the " interventions to reduce

mother-infant HIV transmission can be implemented successfully on a large

scale in Thailand. " On the basis of clinical trials and pilot programs in

Thailand between 1996 and 1999, the Ministry of Public Health began a

national program to prevent vertical transmission in 2000. The

editorial states, " On the basis of the estimated 20% decrease in mother-infant

HIV transmission among the 15,000 babies born to HIV-infected women,

the Thai national program has the potential to prevent approximately

3,000 infant HIV infections each year. " The note concludes, " In addition

to reducing mother-infant transmission, such programs can improve

voluntary counseling and testing services, reduce the sexual transmission of

HIV, promote informed decisions about childbearing, and link

HIV-infected persons to health and social services " (Morbidity and Mortality

Weekly Report, 7/20). Also available in this issue is a list of the 25

most notable HIV/AIDS reports published in MMWR.

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The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a

free service of The Henry J. Kaiser Family Foundation, by National

Journal Group Inc.© 2001 by National Journal Group Inc. and Kaiser Family

Foundation. All rights reserved. www.kaisernetwork.org