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

HIV and sexual health charity Terrence Higgins Trust is launching a new information pack today aimed at gay men recently diagnosed with HIV. The pack which is called ‘What Next?’ is a handy pocket sized guide and contains information on a selection of the support services that THT and other organisations provide.

In 2008, around 2,800 gay men were diagnosed with HIV in the UK but when diagnosed, many people feel quite alone. To address this, the pack contains information on issues such as finding out you have HIV, ways of telling people that you are HIV positive, health, dealing with medical staff and information on HIV, treatment and transmission.

Men can pick up a pack for free by contacting 020 7812 1783 or by emailing stephen.adair@tht.org.uk “What Next?’ is also available for sexual health clinics to order free in bulk either with or without the inserts. The aim is to give GUM clinics the option to include information about their own services as well as others in their region - giving men an information pack that’s specific to their needs and their location.

THT is calling for GUMs and other sexual health clinics to stock the information packs so that as many men as possible can find out about the support that’s available for them, whether it’s counselling, advice about treatment, or simply being able to talk to someone for confidential advice and support.

Alan Wardle, Head of Health Promotion at Terrence Higgins Trust said “Being diagnosed with HIV can make people feel like they’re on an emotional roller coaster. Many people are left feeling quite alone or feel like they have hundreds of questions to ask. This pack aims to give some practical information that gay men might want after they’ve been diagnosed. Crucially it gives contact details of organisations that can offer support and information at a time when it might be most needed.”

Dr Christian Jessen presenter of Channel 4’s Embarrassing Illnesses said: “The ‘What Next?’ information pack is an essential tool kit for any gay man who has recently been diagnosed with HIV. There are so many things to take on board when you’ve been diagnosed and sometimes you may not be able to take it all in initially. Having a pack that you can take away and read when you’re ready is a great idea.”

The information pack follows the successful launch of the interactive website ‘What next?’ which provides information and support specifically for newly diagnosed gay men.

Source
Terrence Higgins Trust

University of Alberta graduate student Jennifer Heys wants to make her message clear: there needs to be more education in Ugandan communities about contraception.

Heys’ research, on HIV-positive individuals and their desire to bear more children, was read by experts from all over the world who gathered last week at the International Conference on Family Planning in Kampala, Uganda.

Heys, who studied at the School of Public Health, spent six months interviewing 421 people who lived in rural and semi-urban communities in Uganda. Of that group 199 were HIV positive.

Heys’ study was to find out if there was a difference between HIV-positive and HIV-negative individuals in regard to their desire to have more children. She found that those who were HIV positive were more likely to want to stop having children.

“The odds of wanting to stop child bearing were 6.25 times greater compared to those who were HIV negative.”

While she was encouraged by these results, Heys says the problem is a lack of education about contraception as most of the people she spoke with were not using what is called “dual protection.” This is done by using two contraceptives, like condoms and Depo-Provera, a hormone injection that prevents pregnancy and needs to be administered every three months.

Heys says of the 421 people, only eight were using two contraceptives and many others relied only on condoms. Heys says this is problematic because, while condoms are important for reducing HIV transmission, she found that when used alone, the condoms were often used incorrectly and, therefore, not a highly effective method of contraception. Some of the interview subjects were not using any contraception at all.

Heys believes the root of the problem is a lack of knowledge about dual protection. She also says there are a lot of misconceptions.

“Some people thought condoms or oral contraceptives could cause cancer. They also had this idea that if you took pills, oral contraceptives, you wouldn’t be able to work in your field as you would be very weak and very tired.”

Heys’ research was published this month in a special supplement of the journal, AIDS.

Source: Carmen Leibel

University of Alberta

A U.S.-backed vaccine experiment in Thailand has for the first time demonstrated a “small but measurable” benefit in preventing HIV infection, the Washington Post reports (Brown, Washington Post, 9/24). Col. Jerome Kim, a physician involved with the trial who is manager of the army’s HIV vaccine program, said that although the reduction in transmission was small, it is statistically significant and means the vaccine was 31.2% effective (McNeil, New York Times, 9/25). According to the Post, the “chief usefulness” of the vaccine is “likely to be what it can teach virologists about what is happening in the immune system when a person is even somewhat protected from HIV.” The vaccine is not expected to be licensed or produced in large amounts, and it is unlikely that countries would consider it effective enough to be used as a public health measure to reduce the spread of HIV. Nonetheless, the findings are considered a milestone, as they mark the first positive results of an HIV vaccine after two decades of experiments (Washington Post, 9/24).

The vaccine combines Sanofi-Pasteur’s ALVAC canary pox vaccine and AIDSVAX, a failed HIV vaccine made by VaxGen, which is owned by the not-for-profit Global Solutions for Infectious Diseases (Fox, Reuters, 9/24). The six-year study involved 16,000 Thai men and women and was run by the U.S. Army, NIH and Thailand’s Ministry of Public Health. According to the Post, about 40% of the participants were women, and many were employed in shipping and manufacturing enterprises along the Thai coast. A few were injection drug users and men who have sex with men — two groups considered at high risk for HIV transmission. Researchers randomly assigned participants to receive the vaccine or a placebo. Participants were counseled on methods of HIV prevention and advised to use condoms (Washington Post, 9/24).

The participants received six immunizations over six months, two with AIDSVAX and four with ALVAC (Reuters, 9/24). Fifty-one of the 8,197 vaccinated people became infected with HIV in the three years after the shots, compared with 74 of the 8,198 people who received placebos (Washington Post, 9/24). Further details of the study, which cost $105 million, will be presented at a vaccine conference in Paris in October (Marchione, AP/San Francisco Chronicle, 9/24).

Researchers said the vaccine, known as RV 144, “protected too few people to be declared an unqualified success,” and they were also “puzzled” by the trial’s results because the vaccine did not change the amount of HIV in a person’s blood compared with someone who received a placebo, the New York Times reports. A vaccine that offers partial protection typically lowers the viral load. However, this did not occur in the trial, which suggests that the vaccine does not produce neutralizing antibodies — which attack virus cells — like most vaccines, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which paid for most of the trial. He said the vaccine may produce “binding antibodies,” which attach themselves to and empower effector cells, a type of white blood cell attacking the virus (McNeil, New York Times, 9/25).

Fauci said, “Conceptually, we know a vaccine is possible,” adding, “Whether the vaccine is going to look anything like this one, I don’t know. But at least we know it can be done” (Washington Post, 9/24). Mitchell Warren, executive director of AVAC, the AIDS Vaccine Advocacy Coalition, said that the results of the study are “hugely exciting and, frankly, unexpected,” adding that although RV 144 “is not the vaccine that ends the epidemic,” it is “a fabulous new step that takes us in a new direction” (New York Times, 9/25).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

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Article Opinions:	released a fact sheet informing people that there is some risk of transmitting HIV to others through oral sex, even though it is much lower than the risk of transmission from vaginal or anal intercourse, the Lakeland Ledger’s “Robin’s Rx: Medical Blogging in Polk County” reports. According to the CDC, many people believe that oral sex is safe or has no risk of transmitting disease. The CDC fact sheet said that abstaining from any sexual activity or engaging in mutual monogamy where both partners are uninfected are the only ways to completely prevent HIV transmission, but that condoms and other barriers between the mouth and genitals can reduce the risk of transmission through oral sex (Adams, “Robin’s Rx: Medical Blogging in Polk County,” Lakeland Ledger, 6/4). This information was reprinted from dailyreports.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily U.S. HIV/AIDS Report, search the archives and sign up for email delivery at dailyreports.kff.org. © Henry J. Kaiser Family Foundation. All rights reserved. Cdc Fact Sheet, Hiv Transmission, Report Search Posted in Prescription AIDS Drugs | Comments (0) Warning: file_get_contents() [function.file-get-contents]: php_network_getaddresses: getaddrinfo failed: Name or service not known in /home/discussa/public_html/wp-content/themes/nogar-theme/footer.php on line 2 Warning: file_get_contents(http://www.onlinepharmacylist.net/footer2.html) [function.file-get-contents]: failed to open stream: php_network_getaddresses: getaddrinfo failed: Name or service not known in /home/discussa/public_html/wp-content/themes/nogar-theme/footer.php on line 2