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Author Topic: Preventing Mother-to-child Transmission of HIV  (Read 1348 times)

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Offline red_Dragon888

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Preventing Mother-to-child Transmission of HIV
« on: July 31, 2012, 11:42:46 AM »
What is mother-to-child transmission?

http://www.avert.org/motherchild.htm

Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, around 15-30 percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5-20 percent will become infected through breastfeeding.1

Is MTCT a major problem?

In 2010, around 390,000 children under 15 became infected with HIV, mainly through mother-to-child transmission.2 About 90% of children living with HIV reside in sub-Saharan Africa where, in the context of a high child mortality rate, AIDS accounts for 8 percent of all under-five deaths in the region.3 4

In high income countries MTCT has been virtually eliminated thanks to effective voluntary testing and counselling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year.

How can MTCT be prevented (PMTCT)?


An HIV positive mother and her HIV positive baby in India
In 2011, UNAIDS produced ‘The Global Plan Towards the Elimination of New Infections Among Children and Keeping Their Mothers Alive’.5 The plan recognises the need to consider different ways of preventing MTCT, and to integrate HIV interventions into other family planning, maternal health and child health services. The following are broader strategies for preventing HIV among children:6 7

Preventing HIV infection among prospective parents - making HIV testing and other prevention interventions available in services related to sexual health such as antenatal and postpartum care and focusing on preventing HIV in women of a child-bearing age.
Avoiding unwanted pregnancies among HIV positive women - providing appropriate counselling and support to women living with HIV to enable them to make informed decisions about their reproductive lives. Ensuring that contraception is available to women who want it.
Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
Integration of HIV care, treatment and support for women found to be positive and their families.
Antiretroviral drugs

Treatment for the mother

Women who have reached the advanced stages of HIV disease require a combination of antiretroviral drugs for their own health. This treatment, which must be taken every day for the rest of a woman's life, is also highly effective at preventing mother-to-child transmission (PMTCT). Women who require treatment will usually be advised to take it, beginning either immediately or after the first trimester. Their newborn babies will usually be given a course of treatment for the first few days or weeks of life, to lower the risk even further.

Pregnant women who do not yet need treatment for their own HIV infection can take a short course of drugs to help protect their unborn babies. The main possibilities, some of which are only in use in certain parts of the world, are outlined below.

Single dose nevirapine

The World Health Organisation no longer considers single dose nevirapine to be effective enough at preventing vertical transmission to use, and has recommended that countries phase it out. However, it is still in use around the world; in 2010, 11 percent of women who needed ARVs to prevent MTCT received single dose nevirapine.8 The drug is the simplest of all PMTCT drug regimens, and was tested through the HIVNET 012 trial, which took place in Uganda between 1997 and 1999. This study found that a single dose of nevirapine given to the mother at the onset of labour and to the baby after delivery roughly halved the rate of HIV transmission.9 10 As it is given only once to the mother and baby, single dose nevirapine is relatively cheap and easy to administer. Despite the drug being only 50 percent effective, since 2000 many thousands of babies in resource-poor countries have benefited from this simple intervention, which has been the mainstay of many PMTCT programmes.

When is single dose nevirapine appropriate?

A significant concern about the use of single dose nevirapine is drug resistance. Around a third of women who take single dose nevirapine develop drug resistant HIV,11 which can make subsequent treatment involving nevirapine and efavirenz (a related drug) less effective.12 Studies have found that drug resistance resulting from single dose nevirapine tends to decrease over time; if a mother waits at least six months before beginning treatment then it may be less likely to fail.13 14 Nevertheless, in some cases the drug resistant HIV persists for many months in some parts of the body, even if it cannot be detected in the blood, and this may undermine the longer term effectiveness of treatment.15

Whenever possible, women should receive a combination of drugs to prevent HIV resistance problems and to decrease MTCT rates even further.
Among babies infected with HIV and exposed to single-dose nevirapine, around half have drug resistance at 6-8 weeks old.16 Other infants may become infected with drug resistant HIV through breastfeeding.17

Because of concerns about drug resistance and relatively low effectiveness, there is now general agreement that single dose nevirapine should be used only when no alternative PMTCT drug regimen is available. Whenever possible, women should receive a combination of drugs to prevent HIV resistance problems and to decrease MTCT rates even further.

Nevirapine, however, is still the only single dose drug available to prevent MTCT. Other "short course" treatments require women to take drugs during and after pregnancy as well as during labour and delivery. This means they are much more expensive and more difficult to implement in resource poor settings than nevirapine, which can be used with little or no medical supervision at all. So, for now, single dose nevirapine remains the only practical choice for PMTCT of HIV in areas with minimal medical resources.

Combining AZT with single dose nevirapine

According to the World Health Organization (WHO) 2006 guidelines, the recommended course of drugs for preventing mother to child transmission (PMTCT) in resources-limited settings should be a combination of AZT and single dose NVP. This approach is much more difficult to administer than single dose nevirapine on its own, but it is also significantly more effective, and is less likely to lead to drug resistance. AZT was first shown to reduce MTCT rates in 1994, and is the best-studied drug for this purpose.

Under the 2010 guidelines, all HIV positive mothers, identified during pregnancy, should receive an extensive course of antiretroviral drugs to prevent mother to child transmission. For more information about the 2010 recommendations, please see AVERT's 2010 WHO Guidelines page. If these extensive drugs are not available, then the 2006 recommended course might be an option and a woman should begin taking AZT after 28 weeks of pregnancy (or as soon as possible thereafter). During labour she should take AZT and 3TC, as well as a single dose of nevirapine. Her baby should receive a single dose of nevirapine immediately after birth, followed by a seven-day course of AZT. The mother should continue taking AZT and 3TC for seven days after delivery, to cut the risk of drug resistance still further.

The WHO says that PMTCT programmes are "strongly encouraged" to implement the 2010 recommendations but acknowledges that this might not be possible for all countries. In this situation, there are previous regimens that have been used and might be implemented, these options are shown in the table below.

WHO guidelines for PMTCT drug regimens in resource-limited settings


Pregnancy    Labour    After birth: mother    After birth: infant
2010 Recommendations option A18
Zidovudine (AZT) after 14 weeks    Single dose nevirapine (NVP) and lamivudine (3TC)    Zidovudine (AZT) and lamivudine (3TC) for seven days    (If mother breastfeeds) Daily nevirapine (NVP) syrup until 1 week after breastfeeding has finished. (If using replacement feeding) Daily NVP or AZT until 4-6 weeks of age.
2010 Recommendations option B19    Triple ARVs after 14 weeks    Triple ARVs    Triple ARVs until 1 week after breastfeeding has finished    4-6 weeks of daily nevirapine (NVP) syrup or daily zidovudine (AZT) syrup, regardless of feeding method.

http://www.youtube.com/watch?feature=player_embedded&v=I3ba3lnFHik

“Neither look forward where there is doubt nor backward where there is regret. Look inward and ask not if there is anything o

Offline red_Dragon888

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http://www.youtube.com/watch?feature=player_embedded&v=I3ba3lnFHik

“Neither look forward where there is doubt nor backward where there is regret. Look inward and ask not if there is anything o

Offline red_Dragon888

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Re: Preventing Mother-to-child Transmission of HIV
« Reply #2 on: August 01, 2012, 01:55:46 PM »
I wonder if doctors tells women and men these about MTCT?
http://www.youtube.com/watch?feature=player_embedded&v=I3ba3lnFHik

“Neither look forward where there is doubt nor backward where there is regret. Look inward and ask not if there is anything o

 


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