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

The global theme of World AIDS Day (1 December 2009) - ‘universal access and human rights’ - draws attention to the Royal Australian College of General Practitioners’ (RACGP) emphasis on the importance GPs have in providing people with HIV infection with the tools to live a healthy life.

“High quality general practice care is important for people living with HIV infection. GPs are often the first port of call for people with HIV infection and GPs have an important role in the prevention of HIV and the provision of care and support of Australians living with HIV,” said Dr Chris Mitchell, RACGP President.

“The majority of infectious diseases in the community worldwide are treated by general practitioners.

“As treatments improve for HIV infection, general practitioners around the world are more involved with disease management.

“HIV disease affects many systems of the body, requires long term monitoring and long term psychosocial support: all characteristics of conditions ideally suited to the primary care setting.

“Australian GPs have been involved in the diagnosis and management of HIV infection since the beginning of the epidemic in Australia and continue to play a leading role.

“New management challenges arise everyday as people with HIV live longer, thanks to new treatments. We are now encountering people in their 60s and 70s who have been living with HIV infection for years.

“GPs have witnessed the evolution of HIV disease from life threatening infection to a chronic disease that can and should be managed in a primary care setting.

“We’re here for the long haul and we will continue to help prevent and diagnose HIV infection and support all of our community members living and affected by the HIV epidemic, which is all of us,” said Dr Mitchell.

Source
The Royal Australian College of General Practitioners

On August 19, Dr. Michel G. Bergeron, director of the Centre de recherche en infectiologie (CRI) of Laval University, will receive the 2009 Canadian Medical Association’s (CMA) Medal of Service. This medal is being presented in recognition of Dr. Bergeron’s outstanding contribution to the medical profession, medical and research organizations, the Canadian health care system, and the well-being of patients around the world.

The CMA Medal of Service is awarded to an individual who has made an exceptional and outstanding contribution to the advancement of health care in Canada. Dr. Bergeron is an internationally renowned clinical researcher and specialist in infectious diseases.

“Thanks to Dr. Bergeron’s remarkable work, thousands of patients have benefited from an improved quality of life. He has contributed concretely to the prevention and diagnosis of infectious diseases. Dr. Bergeron’s accomplishments deserve our admiration,” says CMA President Dr. Robert Ouellet.

“I wasn’t expecting such an honour. I’m very proud, and I must thank all those who have always believed in me and supported me in my personal life, medical practice and research,” says Dr. Bergeron.

After obtaining his medical degree at Laval University in 1968, Michel Bergeron completed his residency in internal medicine at McGill and went on to a research fellowship in infectious diseases at the New England Medical Centre Hospital, Tufts University in Boston. He then returned to his hometown of Quebec City. In 1974, he was appointed assistant professor of microbiology at Laval. That same year, he founded the university’s laboratory in infectious diseases research, later named Centre de recherche en infectiologie (CRI), which today ranks as the largest infectious disease research centre in Canada. Dr. Bergeron teaches at Laval University and internationally as a visiting professor.

An outstanding career path

Early in his career, Dr. Bergeron focused his research on the treatment of infectious diseases. A direct product of his work is the first-line treatment of severe pyelonephritis with intravenous aminosids, which reduced treatment time from 14 to 3 days.

Over the years, Dr. Bergeron has turned his attention to the development of new preventative approaches to infectious diseases. His main area of interest is increasing the rapidity of microbiological diagnosis using DNA analysis of microbial genes.

With his team at the CRI, Dr. Bergeron developed the first rapid, real-time tests to detect certain disease-causing microbes in less than one hour, instead of the 48 hours usually required.

Keenly interested in the transfer of technology, Dr. Bergeron created Infectio Diagnostic Inc. in 1995, to develop and market rapid diagnostic tests. Today the company, which was acquired by Becton Dickinson & Co. in 2006, employs several hundred people in Quebec City and promises continued growth and technological advances.

“My greatest passion and my greatest dream are to discover new technologies and simple and rapid new tests that can be administered at point of care, such as doctors’ offices, emergency and intensive care departments, pharmacies and even, one day, in developing countries. This would revolutionize medical practice by making it possible for medical staff to diagnose infectious diseases, in real time, and thus save countless lives,” says Dr. Bergeron.

One of Dr. Bergeron’s priorities is the fight against HIV-AIDS. A few years ago, he and his colleagues began work on developing an “Invisible Condom®” or vaginal gel formulation that women could use to protect themselves against AIDS, sexually transmitted diseases and cervical cancer. Phase I and II trials have been completed and the product, which is entering the Phase III clinical trial, is of enormous importance to women around the world.

Involvement

Dr. Bergeron’s busy laboratory pursuits have not kept him from being actively involved in Canada’s research community, including the:

• Scientific Advisory Board of the Canadian Space Agency and the Global Health Initiative of the Bill and Melinda Gates Foundation (committee member)

• Scientific Advisory Board of the Council of Canadian Academies (member)
• Scientific Advisory Board of Infectiopole Sud in France (chair)
• Canadian Association for HIV Research and the Canadian Foundation of Infectious Diseases (co-founder)
• Canadian Society for Clinical Investigation and the Canadian Association of Medical Microbiologists (former chair)
• National Advisory Committee on SARS and the Standing Committee on Sciences and Research of the Medical Research Council of Canada (former member).

Honours

Dr. Bergeron’s scientific discoveries and involvement have earned him numerous honours, including the:

• Quebec Wilder-Penfield Award

• Order of Quebec
• “Medecins de merite de l’Actualite Medicale, 20th anniversary” Henry Friesen Award co-sponsored by CSCI and RCPSC
• Laval University award “Grands Diplômes”
• CIHR Synapse award for the CRI’s weekly “Researcher for a day” program (introducing high school students to sciences)
• Lifetime Achievement Award of the Association of Medical Microbiology and Infectious Disease Canada
• Fellow of the Infectious Diseases Society of America and of the Canadian Academy of Health Sciences

Dr. Bergeron is the 39th recipient of the CMA Medal of Service. The medal will be presented at a special ceremony, which will take place at TCU Place in Saskatoon during the 142nd Annual Meeting of the Canadian Medical Association.

Source:
Sarah Sanchez

Universite Laval