Kaiser Daily HIV/AIDS Report - Tue, 11 Dec 2001
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'Monumental' HIV/AIDS Study in Botswana Will Use Two-Pronged Approach
to Preventing Vertical Transmission
Researchers in Botswana and the United States are teaming up to con-
duct a "monumental" research project aimed at preventing the vertical
transmission of HIV to newborns in Botswana, a country in which al-
most 50% of women may be HIV-positive, the Globe and Mail reports.
The research project, named Moshi after the Setswana word for milk,
will be a collaborative effort between Harvard University researchers
and hospital officials in Mochudi, Botswana. Researchers will employ
two distinct techniques to prevent mother-to-child transmission of
HIV, one aimed at reducing transmission before and during birth, and
another targeting transmission through breast milk. The first program
will supplement the AZT that HIV-positive pregnant women already re-
ceive through Botswana's national program with a second antiretrovi-
ral drug, nevirapine. Because AZT alone can reduce vertical transmis-
sion of HIV by 50% to 80%, researchers hope that by adding nevirap-
ine, which can also reduce transmission by up to 50%, they can
"eliminate in utero and delivery [HIV] infections in newborns." The
combined cost of the two-drug regimen will be less than US$ 45 per
person. The second part of the study will examine data to address the
controversial "dilemma" of whether or not HIV-positive mothers should
be encouraged to feed their babies formula or breast milk. Even with
government-subsidized infant formula, an HIV-positive woman's deci-
sion about whether to breastfeed is not a "clear-cut choice," Bot-
swana-Harvard AIDS Partnership researcher Carolyn Wester said.
Breastfeeding, which is the "cultural norm" in Botswana, is responsi-
ble for approximately one-third of mother-to-child transmissions of
HIV, but it also provides newborns with antibodies that boost their
immune systems and protect them from numerous other life-threatening
diseases. The researchers will give the breastfed newborns of HIV-
positive mothers a "daily syrup containing AZT" and will compare the
rate of HIV infection in those newborns to that of formula-fed in-
fants born to HIV-positive mothers. More than 80% of Botswana's HIV-
positive pregnant women have already signed up to participate in the
research study (Globe and Mail, 12/8).
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