E-DRUG: WHO/UNAIDS on MTCT and nevirapine
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[joint WHO/UNAIDS pressrelease, issued 25 October. WB]
Preventing Mother-to-Child HIV Transmission - Technical Experts
Recommend Use of Antiretroviral Regimens Beyond Pilot Projects
Experts Say Benefits Outweigh Potential Adverse Effects
Geneva, 25 October 2000: Experts have concluded the safety and
effectiveness of antiretroviral (ARV) regimens which prevent HIV
transmission from mother to child warrant their use beyond pilot
projects and research settings.
According to a technical consultation held in Geneva from 11-13
October 2000, the prevention of mother-to-child transmission of HIV
� the virus that causes AIDS - should be included in the minimum
standard package of care for HIV-positive women and their children.
The meeting also recommended that 'there is no justification to
restrict use of any of these regimens to pilot project or research
settings.'
'We welcome these new recommendations, particularly those
relating to the use of nevirapine', said Dr Awa-Marie Coll-Seck,
UNAIDS Director of Policy, Strategy and Research. 'It is my
sincere hope that more women will now have access to mother-to-
child prevention programmes in developing countries'.
'A number of available regimens are known to be effective and
safe,' said Dr Winnie Mpanju-Shumbusho, Director of the
HIV/AIDS/STI Initiative of WHO. 'The choice should be determined
according to local circumstances on the grounds of costs and
practicality, particularly as related to the availability and quality of
antenatal care.'
The safety of preventive treatments including zidovudine alone,
zidovudine and lamivudine, and nevirapine, has been studied
extensively for both breastfeeding and non-breastfeeding
populations worldwide. Information currently available does not
suggest any adverse effects on the health of the mother, growth
and development of infants, or the health and mortality of infants
infected despite prophylaxis.
The most complex regimen includes antepartum and intrapartum
zidovudine for the mother and post-natal doses for the infant. The
simplest regimen requires a single dose of nevirapine at the onset
of labour and a single dose for the newborn. These regimens work
by decreasing viral load in the mother and through prophylaxis of
the infant during and after exposure to virus. Previous
recommendations from March 2000 had stated that because of
possible concerns about the rapid development of nevirapine-
resistant virus in women using this intervention, nevirapine should
be used within the context of pilot and research projects only.
While resistant virus may develop quickly to antiretroviral drug
regimens that do not fully suppress viral replication, such as those
including lamivudine and nevirapine, evidence indicates that virus
containing drug resistant mutations decreases once the
antiretroviral drugs are discontinued. Mutant virus may remain
present in an individual in very low levels, which could reduce the
effectiveness of future antiretroviral treatment for the mother.
However, the meeting concluded that the benefit of decreasing
mother-to-child HIV transmission with these antiretroviral drug
prophylaxis regimens greatly outweighs any theoretical concerns
related to development of drug resistance.
The prevention of mother-to-child transmission involves more than
simple provision of antiretroviral drugs. It also requires appropriate
counselling and testing services, as well as support for mothers
and infants, including counselling on infant feeding options.
There is continued concern that up to 20% of infants born to HIV-
positive mothers may acquire HIV through breastfeeding. The
meeting concluded that the guidelines issued in 1998 remain valid.
An HIV-infected women should receive counselling, which includes
information about the risks and benefits of different infant feeding
options, and specific guidance in selecting the option most likely to
be suitable for her situation. The final decision should be the
woman�s, and she should be supported in her choice. For HIV-
positive women who choose to breastfeed, exclusive breastfeeding
is recommended for the first months of life, and should be
discontinued when an alternative form of feeding becomes feasible.
Each year, more than 600 000 infants become infected by
HIV/AIDS, mainly in developing countries. Since the beginning of
the HIV epidemic, an estimated 5.1 million children worldwide have
been infected with HIV. Mother-to-child transmission is responsible
for more than 90% of these infections. Two-thirds are believed to
occur during pregnancy and delivery, and about one-third through
breastfeeding. As the number of women of childbearing age
infected by HIV rises, so does the number of infected children.
The WHO Technical Consultation was held on behalf of the
UNAIDS/UNICEF/UNFPA/WHO InterAgency Task Team on the
Prevention of Mother-to-Child Transmission of HIV. Participants
included scientists, managers of national AIDS control
programmes, HIV-positive mothers, non-governmental
organizations, and United Nations agencies. Participants came
from Africa, Asia, Europe, the Caribbean and the Americas.
For more information, please contact Anne Winter, UNAIDS,
Geneva, (+41 22) 791.4577, Dominique De Santis, UNAIDS,
Geneva, (+41 22) 791.4509, Andrew Shih, UNAIDS, New York, (+1
212) 584.5024, Gregory Hartl, WHO, Geneva (+41 22) 791.4458 or
Tim Farley, Department of Reproductive Health and Research,
WHO, Geneva (+41 22) 791.3310. You may also visit the UNAIDS
Home Page on the Internet for more information about the
programme (http://www.unaids.org).
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