Mothers receiving highly active antiretroviral therapy (HAART) to treat HIV-1 infection are less likely than untreated mothers to transmit the virus to their newborns through breastfeeding, according to a new study. The findings, now available online in the Nov. 15 issue of The Journal of Infectious Diseases, suggest HAART regimens should be initiated as early as possible in eligible mothers in areas with limited resources, such as Africa, where most infant HIV-1 infections occur, and breastfeeding is common.

Led by Taha E. Taha, MBBS, PhD, of Johns Hopkins University Bloomberg School of Public Health, the researchers studied 2,318 infant/mother pairs in Malawi; a total of 130 infants (about 6 percent) became HIV-1-infected. The protective effect of HAART was readily apparent: The therapy was associated with an 82 percent reduction in postnatal HIV-1 transmission. The reduction was observed in mothers with CD4 counts low enough to be eligible for HAART compared to mothers with low counts who did not receive the therapy. Among the infants who became HIV-1-infected, only five had mothers who were both eligible for HAART and actually received it, representing a transmission rate of 1.8 percent. In contrast, 53 infected infants had mothers who were HAART-eligible but who went untreated (a 10.6 percent transmission rate). Seventy-two other infected infants had mothers who were HAART-ineligible because their CD4 cell counts were consistently high (a 3.7 percent transmission rate).

While acknowledging more research is needed to develop safe, effective, and affordable ways to prevent postnatal transmission in settings with few resources, the study’s authors recommend that women presenting late in pregnancy who have low CD4 counts and require antiretroviral treatment start HAART as soon as possible during pregnancy or postpartum. For women who do not need HAART for their own health because of a high CD4 count - and who represented approximately 70 percent of the Malawi patients studied - the investigators noted that the choices are unclear. The options include prolonged infant antiviral prophylaxis beyond 14 weeks of age or the institution of HAART in mothers who do not require the therapy according to current guidelines.

The authors had reported in 2008 that daily use of either nevirapine or nevirapine and zidovudine from birth up to the age of 14 weeks in breastfeeding infants of HIV-1-infected mothers reduced the rate of infant infection by 67 percent, compared to infants who received only a single dose of nevirapine and one week of zidovudine.

In an editorial accompanying the authors’ latest article, Grace C. John-Stewart, MD, PhD, of the University of Washington School of Public Health, noted that programs to prevent mother-to-child transmission of HIV need to accelerate in many ways. Globally, there are still large gaps in HIV-1 testing and CD4 count availability, which are necessary to identify women infected with the virus and determine if HAART is right for them. “Recognizing the impact of prompt HAART initiation in eligible women and finding efficiencies in CD4 testing and delivery of HAART services will leverage antenatal HIV-1 testing to increase maternal survival and decrease infant infections,” Dr. John-Stewart said.

Source:
John Heys

Infectious Diseases Society of America

From January 27, HIV and sexual health charity Terrence Higgins Trust (THT) will be running a new three month City & Guilds course in understanding HIV and AIDS. The distance learning based course is structured into three units with two face to face study days held in central Manchester and 20 hours of study time for each unit.

The qualification is designed for people interested in HIV and AIDS or working in a role where knowledge of the issue would be beneficial to their work. It’s ideal for people who work in a variety of roles including nurses, GP reception staff, voluntary workers, probation officers, police officers, teachers, social services staff, staff in drug support services and residential care services as well as interested individuals.

Joanna Hurren Head of Function at City & Guilds said “The course could help to open the door to a career in the HIV sector. Alternatively, it could help to support a person’s career development if they are already working in a role where it’s beneficial to be aware of the issues relating to HIV and AIDS.”

Areas of study on the course include:

- Transmission and prevention of HIV
- Stigma and discrimination in HIV and AIDS
- Managing HIV and AIDS

Jackie Redding, Director of Social Care and Service Development for THT said: “We’re delighted to be running this course in Manchester. It aims not only to raise awareness of HIV but also to reduce the stigma that still exists. I’d encourage anyone interested to get in touch and find out more.”

To sign up for the course or get further information visit http://www.tht.org.uk/cityandguilds.

Notes

City & Guilds is the expert and leading authority in vocational education and training - both in the UK and beyond. In operation for the last 130 years, City & Guilds is the UK’s leading awarding body for work-related qualifications. Twenty million people in the UK have City & Guilds qualifications, and the organisation awards a further 1.5 million qualifications to learners every year.

Source
Terrence Higgins Trust

The International AIDS Vaccine Initiative (IAVI) announced that it has signed a memorandum of understanding with the Ragon Institute to accelerate the development of new and promising AIDS vaccine candidates for testing. Formed in February 2009, the Ragon Institute was officially established at Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard University to help bring fresh perspectives and encourage cross-disciplinary collaborations to contribute to the discovery of an HIV/AIDS vaccine.

As part of this partnership, the Ragon Institute and IAVI will work together to identify promising concepts generated by the Institute that can be further developed and ultimately advanced to clinical trials with technical support from IAVI. In addition, this partnership is intended to facilitate productive exchanges among leading researchers affiliated with both IAVI and its network of scientific consortia and the Ragon Institute.

“We are honored to be working with the Ragon Institute and hope that this collaborative approach will take us a step further in devising new vaccine strategies and candidates to defeat HIV,” said Seth Berkley, MD, President and CEO of IAVI. “AIDS knows no boundaries, and neither should the scientists working to develop a vaccine to bring an end to one of the world’s leading killers.”

“This partnership offers great promise to help accelerate progress towards developing a vaccine to stop the AIDS pandemic,” said Phillip T. Ragon, who together with his wife Susan provided the funding to establish the Ragon Institute. “With declining interest in vaccines by pharmaceutical companies, public- private product development partnerships (PDPs) like IAVI have become a critical resource. This partnership will be indispensable in providing the speed, flexibility and technical expertise to advance promising early-stage concepts that will arise from the scientists at the Ragon Institute. As someone personally committed to helping solve the AIDS problem, I am excited to have this relationship with IAVI to help us move forward with the greatest possible speed.”

According to the Global Forum for Health Research, PDPs play an important role in addressing the widening gap in the availability of medicines and vaccines for neglected diseases. PDPs bring together skills, knowledge and resources from a variety of sectors including academia, nongovernmental organizations, philanthropists, government and intergovernmental agencies, as well as members of the for-profit private sector such as pharmaceutical and biotech companies, and apply them to solving some of the major global health challenges facing us today.

“Traditionally, it has been very difficult to convince the private sector to invest in medicines and vaccines for neglected diseases,” said Bruce Walker, MD, an MGH physician-investigator and director of the Ragon Institute. “I look forward to addressing this critical gap in AIDS vaccine discovery with IAVI, which has the technical expertise that will enable us to quickly advance the best concepts coming out of the Ragon Institute into clinical trials.”

Source
IAVI