AIDS epidemic in Eastern and Southern Africa is outpacing response, says UNAIDS

Efforts to combat HIV/AIDS in Eastern and Southern Africa are failing to keep up with the growth of the epidemic, according to experts from UNAIDS ahead of a review of the global HIV/AIDS response.

In June 2008, UN member states, government officials and AIDS activists from around the world will meet in New York to track progress on targets adopted by the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in 2001.

Countries submit reports every two years on targets including 25 core indicators on national HIV prevalence, education, provision of antiretroviral treatment (ART), uptake of condoms, and assistance to orphans.

Having assessed recent reports from Eastern and Southern Africa, the regions worst affected by the HIV/AIDS crisis, experts from UNAIDS have concluded that despite significant progress in areas such as treatment, many of the UNGASS targets are still far from being reached.

Director of UNAIDS for Eastern and Southern Africa, Mark Stirling said, "The data presented by countries confirms that overall the rate of progress in expanding access to all services is failing to keep pace with the expansion of the epidemic in this region.”

While treatment coverage has increased by 50 percent in low and middle-income countries in the region between December 2006 and the end of 2007, UNAIDS experts reported disappointing progress in HIV prevention in the region. Some countries showed a decrease in HIV prevalence among people aged 15 to 24, but others reported no change or slight increases.

The reported lack of progress has sparked debate among AIDS organisations about the usefulness of short term targets like those set by UNGASS, as opposed to strategies with an extended timeframe that focus on the social and cultural factors driving the HIV/AIDS epidemic.

The renewed focus on progress in HIV prevention is hoped to provide fresh impetus to all working towards HIV/AIDS prevention throughout the world to redouble their efforts.

AVERT has more on the impact of AIDS in Africa.

(PlusNews, 24/04/08)

HIV/AIDS leads to increased deaths of mothers and babies in South Africa

South Africa is not likely to meet the Millennium Development Goals to reduce maternal and child mortality by 2015, unless efforts are made to significantly improve the quality and coverage of healthcare, according to a recent report published in the Lancet.

The report, “Every Death Counts”, states that as a result of unequal access to healthcare, high incidence of HIV/AIDS, and other complications, rates of maternal and neonatal mortality have not improved, and mortality in children younger than 5 has increased in South Africa.

At least 260 women, babies and children die every day in South Africa, and no measurable progress has been made to reduce this mortality rate.

The report recommends that better quality and coverage of measures for preventing mother-to-child transmission of HIV (PMTCT), as well as improving healthcare for HIV positive women, will be crucial for improving maternal and child survival.

Although the rate of new HIV infections is stabilising in South Africa, and the number of children receiving HIV treatment has increased, nearly a third of pregnant women in South Africa are HIV positive. The report estimates that 35% of child and neonatal deaths are due to HIV/AIDS.

In order to meet the Millennium Development Goal of reducing the mortality rate among children under five by two thirds by 2015, South Africa must achieve an average yearly rate of reduction in child mortality of 14%.

This can be achieved through addressing unequal access to health care services by reaching South Africa’s poorest and most marginalised populations, and by integrating HIV/AIDS care into all health interventions for mothers and children.

AVERT has more on HIV and AIDS in South Africa.

(The Lancet, 12th April 2008) 

Egypt accused of HIV ‘crackdown’

Five gay men, four of them HIV positive, were on Wednesday sentenced by an Egyptian court to three years in prison for "habitual practice of debauchery", a term which in Egyptian law includes consensual sexual acts between men.

The five men were arrested in what human rights groups have described as a crackdown on people living with HIV, using the debauchery charges as a means to prosecute them.

The recent convictions come after a string of arrests for debauchery charges, totalling 12 men. The crackdown began in October 2007, when police arrested a man during a street altercation. After one of the men said he was HIV-positive, authorities began investigating others whose names or contact information they found through interrogating the first detainees.

Four of the five men convicted on Wednesday tested HIV-positive after all the men were forced to undergo HIV tests in custody.

In a statement issued by Human Rights Watch, 117 organizations around the world condemned the prosecutions as being driven by ignorance and fear of AIDS. They also condemned human rights violations such as forcible HIV testing without consent, and arbitrary arrests and ill-treatment based on HIV status.

The organisations have warned that the convictions could undermine HIV prevention in Egypt.

Egyptian police have denied making any arrests because of a person's HIV condition.

Read more about the stigma associated with HIV and men who have sex with men.

(Human Rights Watch, 07/04/08, Associated Press, 10/04/08) 

Improvements in preventing HIV transmission from mother to child, but more progress needed

The number of HIV positive pregnant women receiving drugs to prevent their babies being born with HIV increased by 60% between 2005 and 2006; yet more needs to be done, according to a report released by the World Health Organization (WHO), UNAIDS and UNICEF yesterday. 

 The “Children and AIDS, Second Stock Taking report” focusses on four key issues in low and middle-income countries, namely the provision of antiretroviral drugs to prevent mother-to-child transmission of HIV (PMTCT), the provision of HIV treatment to children, preventing new HIV infections in children and young people, and the protection and support of young people affected by HIV.

In 2006, 351,034 HIV positive pregnant women living in low and middle income countries received drugs to prevent their babies being born with HIV, compared with 220,085 in 2005, a 60% increase.

The report also shows that the number of HIV positive children benefiting from AIDS treatment programmes increased by 70 per cent between 2005 and 2006. Furthermore, a decline in HIV prevalence was found among 15 to 24 year old women attending antenatal clinics since 2000-2001 in 11 of the 15 countries with sufficient data.

The new findings represent substantial progress towards preventing mother-to-child transmission of HIV, especially in sub-Saharan Africa. By the end of 2006, 21 low and middle-income countries were on track to meet the Millenium Development Goal of 80 per cent PMTCT coverage by 2010.

Despite these improvements, the report highlights the millions of women who are still not able to access PMTCT services. The proportion of HIV positive pregnant women who received drugs to prevent their babies being born with HIV stands at only 23% of those in need. Government must make greater efforts to provide access to PMTCT services by strengthening health systems, reducing HIV related stigma, strengthening families and communities; all factors which provide obstacles for PMTCT coverage.

AVERT is campaigning to improve PMTCT services worldwide with our Stop AIDS in Children campaign. 

(UNICEF Press Release, 03/04/08)  

PEPFAR receives overwhelming support for its reauthorisation

The House of Representatives passed a bill on Wednesday that would see a vast increase in the money spent on the fight against AIDS in Africa and other parts of the world.

The legislation authorises $ 50 billion in funding for AIDS, tuberculosis and malaria programmes over the next five years. The Democratic-led House boosted the initial $ 30 billion, proposed by President Bush, up to $ 50 billion for the next five years.

In a bipartisan agreement the House voted overwhelmingly to expand U.S efforts to combat the global HIV/AIDS epidemic. The move renews the initiative of PEPFAR (the President's Emergency Program for AIDS Relief) created by President George Bush five years ago and now sees it moving beyond the “emergency” stage and into programmes that are now able to be fully supported and sustained over a longer period of time.

The reauthorisation is a direct result of the success of the initiative which has, in the past five years, provided life saving drugs to nearly 1.5 million people around the world, supported care for nearly 7 million people, including 2.7 million orphans and vulnerable children, and prevented an estimated 150,000 infant infections.

The significance of the 2003 legislation means that PEPFAR is now firmly established as one of the leading providers in the world of HIV/AIDS assistance for prevention, treatment and care.

The new legislation also sees the overturning of the controversial and ineffective requirement that one-third of funding for HIV prevention be spent on the promotion of abstinence and fidelity. This earmark applied to global funding of HIV/AIDS prevention previously and was included in the initial 2003 law.

With the 2003 law focusing on 15 countries (12 in Africa plus Vietnam, Guyana and Haiti), the new bill will add a further 17 countries, the majority being in the Caribbean but with 3 more (Malawi, Lesotho and Swaziland) in Africa.

As well as the proven success of the initiative, the reauthorization also owes thanks to the significant majority of Democrats now occupying the House of Representatives. The reauthorisation was approved with 306 to 116 votes, all 116 opponents of its reauthorisation being Republican.

The Senate will now look at a similar bill and once both the Senate and the House of Representatives are agreed, a final bill will be passed on to the President for approval. With President Bush now looking to the success of PEPFAR as his legacy in a presidency dominated by the unpopular Iraq war, it is generally thought that the bill will be approved.

For more information have a look at AVERT's pages on PEPFAR and the global epidemic of HIV/AIDS.

(allAfrica.com 02/04/08)

GlaxoSmithKline says its HIV drug does not increase risk of heart attack

The pharmaceutical company GlaxoSmithKline (GSK) has today released a statement questioning the results of the D:A:D study which found that its HIV drug abacavir was associated with increased risk of heart attack.

The D:A:D (Data Collection of Adverse Events of Anti-HIV Drugs) study explored the link between antiretroviral drugs in the NRTI class and the associated risk of heart attack. NRTIs (Nucleoside Reverse Transcriptase Inhibitors) are often called the "backbone" of HIV combination therapy because most regimens contain at least two of these drugs.

Results from the study suggested that the NRTI abacavir was associated with a 90% increase in the risk of heart attack for those already at cardiovascular risk. Didanosine, another NRTI, was associated with a 49% increase in risk.

GSK today said that analysis of their own data including over 9,000 patients taking abacavir, pooled from 54 clinical trials, showed no risk of heart attack associated with the drug.

Didier Lapierre, Vice President of Clinical Development for Infectious Diseases at GSK said, “The D:A:D findings are unexpected, since we have not seen similar findings in our studies, and we are unaware of any potential biological mechanism that would explain them”.

Researchers from the University of Wisconsin have pointed out that GSK’s analysis was a summary of pooled data in a study that was not designed to detect the occurrence of heart attacks. As such the relevance of the results is limited.

They also highlight that despite the fact that the D:A:D study was observational, and therefore not specifically designed to investigate the risk of heart attack, the increase in risk is so great it cannot be ignored. They calculate that one additional heart attack would be expected for every 11 people treated with abacavir over five years.

Because the associations between the use of abacavir and heart attack were unexpected, and observational studies have recognised limitations for quantifying the types of risk involved in these studies, more research is needed to confirm these results.

HIV positive people taking abacavir are advised not to stop taking treatment without medical advice.

AVERT has more about HIV treatment.

(Aidsmap 02/04/08, GSK Press Release, 02/04/08)

New US data do not show a rise in HIV infections

The HIV surveillance report published by the CDC this week does not show an increase in new infections, contrary to statements made by a leading American AIDS organisation.

According to the new data, the number of HIV diagnoses reported in 2006 was 52,878, whereas the equivalent figure in the previous report was 35,537 in 2005. This increase is entirely due to a rise in the number of areas reporting HIV diagnoses to the CDC. Seven more states are included in the new report, including California, Illinois and Washington. In the areas included in both reports, the number of newly reported HIV diagnoses actually declined slightly.

This contradicts a press release issued yesterday by the AIDS Healthcare Foundation, which said there had been a “catastrophic 48% increase in US HIV infections between the years 2005 and 2006.” In fact there is no evidence of a surge in new infections.

Moreover, the CDC report states that, “not all cases of HIV infection … reported in 2006 reflect diagnoses made during 2006; rather, the reported cases include cases diagnosed during earlier years.” The effect of this factor appears to be significant; for example, over recent years Illinois has reported only a quarter as many AIDS diagnoses as New York, but in 2006 Illinois reported 17% more HIV diagnoses than New York. Therefore the figure of 52,878 cannot be taken as a reliable measure of new infections.

The number of annual HIV infections in the US remains uncertain, but appears to have remained stable over recent years. This reflects a failure of the government’s HIV prevention policies, which aimed to halve the infection rate. 

(AHF press release, 27/03/08 and CDC surveillance report)

Increased funding pledged for AIDS vaccines despite loss of confidence in research

America’s National Institute of Allergy and Infectious Diseases (NIAID) has pledged an increase in funds for AIDS vaccine development, after the failure of Merck’s candidate AIDS vaccine in September 2007, and as a funding crisis threatens South Africa’s leading vaccine development initiative.

AIDS vaccine trials were halted last year when it was found that the potential vaccine not only failed to protect people against HIV but might also have increased the risk of HIV infection. Robert Gallo, co-discoverer of the virus that causes AIDS, last week said of the failed vaccine, “This is on the same level of catastrophe as the Challenger disaster that destroyed a NASA space shuttle”.

In light of this failure, the US based AIDS Healthcare Foundation has called for the end of government funding for HIV vaccine research, saying instead that the money should be spent on effective and proven strategies for HIV prevention.

"Twenty-five years into the epidemic and we are no closer to a vaccine," said Ged Kenslea, spokesman for the AHF. "We don't think our tax dollars should be going to something that doesn't have much hope."

However, Dr. Anthony S. Fauci, director of NIAID, said at a summit held yesterday in Bethesda, "We will not discontinue research, period. Not only will we not decrease it, we will try to increase it".

Fauci said his agency would set aside an additional $ 10 million to $ 20 million next year to fund grants to look into new ideas. About one-third of the NIAID's $ 2.9 billion budget goes to HIV vaccine research.

In contrast, the South African AIDS Vaccine Initiative (SAAVI) this week announced a dramatic cut in its budget. SAAVI has lost a third of its funding as a result of a financial crisis at one of its largest donors, the South African electricity supply company, Eskom.

SAAVI interim director Elise Levendal said, “We are very worried about the future of vaccine research. All the funding agreements came to an end in 2007”.

AVERT has more information on AIDS vaccines.

(The Baltimore Sun, 26/03/08, The Times, 26/03/08)

WHO report says efforts to Confront Tuberculosis are too slow

A new World Health Organisation report says efforts to confront TB are happening far too slowly.

The report, entitled ‘Global Tuberculosis Control 2008 – Surveillance, Planning, Financing’ states that the pace at which new tuberculosis cases are detected worldwide is slowing down. The 12th annual report to be published by WHO, reveals that in detecting new tuberculosis cases the rate of increase was 3% from 2005 to 2006, compared with the previous average of 6% recorded from 2001 to 2005.

The report also found that of the 14.4 million cases of tuberculosis worldwide in 2006, 700,000 of those cases occurred among people who were HIV-positive, and among these, there were 200,000 deaths.

The link between HIV and TB was demonstrated in the report with the findings that the majority of TB cases were from regions where HIV prevalence is also very high. 83% of the total TB cases reported were from Africa, Southeast Asia and Western Pacific regions, with African regions having the world's highest incidence rate per capita.

While 84.7% of reported TB cases have successfully completed treatment - a figure very close to WHO’s target figure of 85% - improvements are still needed. WHO’s treatment programmes have not yet had a major impact on preventing TB transmission around the world, and while TB rates had fallen in some regions and stabilised in Europe, they had not in Africa and instead have increased at least fivefold since the 1990’s.

With funding being another key issue, the much needed increases in budgets are not happening in the majority of countries most heavily affected by the disease.

With TB being the single most important cause of death for people living with HIV, experts and critics have reacted strongly to the report by saying how vitally important it is that more is now done to tackle the disease.

Cases need to be detected early in order to interrupt transmission and provide a better chance of cure; this is something that, going by the report, is not happening.

AVERT has more information around the issue of tuberculosis on our tuberculosis and HIV page.

(AllAfrica.com 19/03/08)

Study shows 1 in 4 American teenage girls has a Sexually Transmitted Disease

A study, released by The Centre for Disease Control and Prevention (CDC), has estimated that one in four (26%) of young women aged between 14 and 19 in the United States is infected with a common sexually transmitted disease.

The study was presented at the 2008 National STD Prevention Conference in Chicago on March 11th of this year and is the first to examine the national prevalence of common STDs among adolescent women in America.

The numbers equate to about 3.2 million teenage girls in the US who are living with at least one of the most common STDs (Human papillomavirus or HPV, Chlamydia, herpes and trichomoniasis).

Sara Forhan, M.D., M.P.H., who led the study, also drew attention to the fact that African-American teenage girls were more severely affected than white teenage girls. About 48% of the African American young women surveyed were infected compared to only 20% of the young white women. Forhan also highlighted that they only tested for the most common diseases and not all, suggesting that the prevalence of all STDs could be a great deal higher.

While many of the infections will clear, some can cause infertility and cervical cancer, showing that STD screening, vaccination and other prevention strategies are of a very high priority if the devastating effects of untreated STDs are to be stopped.

AVERT has a lot more information on STDs and their impact on teens.

(2008 National STD Prevention Conference 13/03/08)

PEPFAR Reauthorisation Bill approves new billions for HIV/AIDS

The Foreign Affairs Committee of the US House of Representatives has approved new legislation for the reauthorization of PEPFAR, President Bush’s Emergency Plan for AIDS Relief.

The legislation represents a compromise between Democrats and Republicans, and is expected to be passed by the House at a later date. The legislation will provide $ 50 billion over the next five years for AIDS, tuberculosis and malaria, which is a significant increase from the $ 30 billion proposed for AIDS spending by President Bush, and will provide the necessary funds to increase and expand the PEPFAR programme.

The legislation amends the requirement that one third of HIV prevention funds be spent on abstinence programmes, a restriction that has been shown to reduce the effectiveness of HIV prevention efforts. The bill calls instead for a balanced prevention programme that would promote every element of the Abstinence, “Be Faithful,” and Condoms (ABC) approach toward HIV prevention. Retained from the original 2003 mandate is the requirement that PEPFAR recipients pledge opposition to commercial sex work.

The increase in funding for PEPFAR will move it beyond an “emergency” intervention by helping to make the programmes that it supports more sustainable over the long term. The new legislation will also provide increased HIV prevention programmes for women and girls; will provide funding for improved food and nutrition, and education and health care programs; and will increase U.S. contributions to the Global Fund for HIV/AIDS, Tuberculosis and Malaria.

The proposal must now be approved by the full House and the Senate.

AVERT has more about PEPFAR.

(Medical News Today, 28/02/08, AllAfrica.com, 27/02/08, New York Times, 29/02/08)

South African doctors support dual therapy for preventing babies being born with HIV

The Southern African HIV Clinicians Society and the Rural Doctors Association are among those who have shown strong support for the KwaZulu Natal doctor who faces charges of misconduct for administering dual antiretroviral therapy to pregnant HIV positive women for preventing mother to child transmission of HIV (PMTCT).

Dr Colin Pfaff of Manguzi hospital has used money donated by AVERT to the Manguzi Mission to provide the antiretroviral drug AZT to an average of 20 HIV positive pregnant women per month since August 2007. The dual therapy regime has long been endorsed by the World Health Organisation, and is a more effective PMTCT drug regimen than nevirapine only, as it is proven to further reduce the rate of mother to child transmission of HIV. Since late January dual therapy has been official policy in South Africa and it is now understood that dual therapy, provided by the government, will be available in KwaZulu Natal from April 1st.

Dr Victor Fredlund, Head of Medicine at nearby Mseleni Hospital defended Pfaff, pointing out that the donated funds were not used within the government health department. "Colin raised the money through the Manguzi Mission fund and it was a donation for the patients not the hospital". He added, “If I had believed that the department could take so long to implement what is its stated objective I too would have sought a cooperative venture with an NGO and the private sector to deliver this service”.

Pfaff has been described by colleagues as “a visionary with a calling to serve the poor”, and, “always (going) the extra mile to serve his patients”.

Updated 21/2/08: All charges against Dr Colin Pfaff have now been dropped.

AVERT's Stop AIDS in Children campaign is calling for improved PMTCT services worldwide.

(AllAfrica.com 10/02/08, Sunday Tribune 17/02/08, Fox News 18/02/08)

Two major setbacks in global search for a microbicide to prevent HIV transmission

The search for a microbicide that could be administered by women before sexual intercourse in order to prevent HIV infection has suffered two major setbacks. The potential microbicide Carraguard has been found to have no effect in preventing HIV infection; and a trial of PRO 2000, another microbicide candidate, has been scaled down.

Carraguard, manufactured from carrageenan, which is derived from seaweed, is the first product developed as a microbicide to complete the final phase of testing. Results from three sites in South Africa showed that while the product was safe, Carraguard did not protect women against HIV infection.

Use of the microbicide among trial participants was low. The researchers stated that only 41% of sex acts would have been covered by the microbicide; a finding that has raised concerns about how effectively women might adhere to a microbicide more generally. It is unclear to what extent poor adherence compromised the efficacy of Carraguard.

Peter Donaldson, president of trial sponsors the Population Council said, “We are disappointed that this trial did not show Carraguard to be effective; nonetheless the completion of this trial is a milestone in HIV prevention research”.

The Population Council has said it was already working on a new candidate microbicide that would use Carraguard as a base for an antiretroviral drug called MIV150.

A phase III trial of another microbicide candidate, PRO 2000, has also reported disappointing news. Testing of a higher dose of the microbicide in a large phase III trial being conducted among women in South Africa, Tanzania, Uganda and Zambia, is to be halted following a review by the Data Monitoring Committee of the UK Medical Research Council.

The review found that it was unlikely that the high dose group, in which women received a microbicide gel containing 2% PRO 2000, would show a significant protective effect against HIV infection compared to a placebo.

However the lower dose arm of the study, in which women receive a 0.5% dose of PRO 2000, will continue, and is expected to report results in 2009.

AVERT has more about the development of microbicides that could prevent HIV transmission.

(Aidsmap 18/02/08, 19/02/08, AllAfrica.com 19/02/08)

Proposed PEPFAR bill would remove restrictions for HIV/AIDS programmes

Democrats have proposed a reauthorisation bill that would make major amendments to PEPFAR, President Bush’s Emergency Plan for AIDS Relief, for the period 2008 to 2013.

The proposed bill would eliminate a provision that at least one third of HIV prevention funds be given to abstinence-based programmes, and it would remove the requirement for PEPFAR recipients to declare that they oppose prostitution.

Furthermore, the bill would allocate $ 50 billion for PEPFAR over the next five years, in contrast to President Bush’s intention to renew PEPFAR with only $ 30 billion. Bush’s announcement has been proclaimed as a potential doubling of PEPFAR funds from the original $ 15 billion in 2003. However, since the 2008 funding allocation grew to $ 6 billion, a $ 30 billion extension would only continue funding at the current rate, rather than provide the needed funds to expand the programme.

The bill is a much-expanded proposal for PEPFAR in comparison to the original mandate passed in 2003; and will be considered later this week by the House Foreign Affairs Committee. Put forward by recently deceased Democrat Tom Lantos, the proposal covers a number of programmes essential for success in HIV/AIDS initiatives, such as care for AIDS orphans, nutrition programmes, malaria and TB programmes, and improving training and retention of health care personnel. The bill also has improved protections for women’s health and rights.

Republican House Leader John Boehner and US Congressman Mike Pence have accused the Democrat bill of undoing carefully crafted rules that allow money to go to family planning groups as long as no money is spent on abortions. Pence said that changes concerning funding for family planning groups would "transform the program into a mega-funding pool for organizations with an abortion-promotion agenda." Concerns surrounding this issue have also been expressed by American organisations such as Family Research Council, Focus on the Family, Concerned Women of America and National Right to Life.

Lantos said the Bush administration has already endorsed the connection between family planning and HIV/AIDS programs, adding that the draft bill clarifies that additional contraceptive services can be provided by law as long as the services are focused on curbing the spread of HIV.

Michael Weinstein, President of AIDS Healthcare Foundation, described the bill’s proposed removal of a 55 percent of funding requirement for AIDS medical care as “grossly inadequate”. The AHF also claimed that the plan to increase the number of people on lifesaving antiretroviral treatment by half is not enough.

Katie Porter, a legislative policy analyst for Population Action International defended the bill, saying it would increase grants to health groups already working overseas to fight HIV/AIDS. "We have this opportunity to dramatically strengthen the programs and reach that many more people, and that would be a big failure on Congress' part to avoid that debate because of an ideological difference about family planning. It's ludicrous that U.S. efforts to combat and prevent HIV wouldn't have a strong family planning and reproductive health component to them".

Democrat Senator Dianne Feinstein said that current PEPFAR requirements "have placed politics above science. The administration's abstinence-before-marriage earmark shortchanges the prevention programs that are most effective".

AVERT has more about PEPFAR and its focus countries.

(AIDS Healthcare Foundation, 07/02/08, Kaiser Foundation 04/02/08, 08/02/08, Business Wire 04/02/08)

Studies show drugs can prevent HIV transmission through breastfeeding

 A collection of studies presented at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston have shown that the risk of HIV transmission from mother to child through breast milk can be reduced using antiretroviral treatment. The first set of studies looked at giving antiretroviral drugs to infants, and another focussed on treatment for HIV positive mothers.

 One study based in Malawi gave the antiretroviral drug nevirapine to babies of HIV positive mothers for 14 weeks. The risk of HIV transmission to infants during breastfeeding was shown to be significantly lower at the end of 14 weeks. Furthermore, by 9 months of age only 7 percent of the infants taking the extended nevirapine regimen had become infected with HIV, compared with 13 percent of those that had received only single dose nevirapine, which is the current standard of care.

In similar trials in Ethiopia, India, and Uganda, babies were given nevirapine for 6 weeks, and were found to have a 50 percent lower risk of HIV infection after this time. Results were combined to evaluate outcomes in overall HIV transmission risk at six months, and infants were found to have a 20 percent lower risk of HIV infection than infants who received only one dose of nevirapine.

Nevirapine is already used widely in resource-limited settings for preventing HIV transmission from mother to child (PMTCT) during pregnancy, labour and delivery. Although breastfeeding poses a risk of HIV transmission to the infant, in some cases it is still recommended for HIV-positive women in resource poor countries, due to other risks associated with formula feeding. The findings could potentially influence World Health Organisation infant feeding guidelines.

The extended nevirapine regimen was found to be safe and effective on the whole, but there is concern about the potential for nevirapine resistance for those infants that did become infected with HIV.

 The second set of results from the Kisumu Breastfeeding Study showed low rates of HIV infection among infants when mothers were given triple combination antiretroviral therapy from late pregnancy through to the sixth month of breastfeeding. In addition, babies received single dose nevirapine within 72 hours of birth. The women were advised to exclusively breastfeed and to wean their children rapidly at six months.

 The researchers state that further assessment is still needed to determine whether this is a feasible strategy for PMTCT among breastfeeding HIV positive women. The study provided this regimen to HIV positive mothers who did not qualify for their own treatment according to WHO criteria.

Both sets of findings represent potential breakthroughs for PMTCT efforts in the developing world, and are likely to provoke debate about the best way of reducing the risk of HIV transmission through breastfeeding.

AVERT has more about HIV and infant feeding. 

 (Aidsmap, 05/02/08, and 05/02/08, Medical News Today, 05/02/08)

Swiss researchers claim HIV positive people receiving treatment do not pass on HIV

The Swiss Federal Commission for HIV/AIDS has released a consensus statement saying that people living with HIV who take effective antiretroviral therapy cannot pass on HIV through unprotected sex, as long as they adhere to antiretroviral drugs, have an undetectable viral load for at least six months, and have no other sexually transmitted infections (STIs).

Before now it has been widely accepted by researchers that HIV positive people with an undetectable viral load have a low risk of passing on HIV to their partners during unprotected sex. Nevertheless, experts have continued to recommend condom use for everyone living with HIV regardless of whether they are receiving treatment. The new statement by the Swiss HIV Commission is controversial for two reasons: it claims that this low risk is actually no risk at all, and also advocates that doctors in Switzerland should advise their patients that they don't need to use condoms if they are adhering to treatment, have an undetectable viral load and don't have any other STIs.

Doubts still remain about the chances of HIV transmission under these conditions however. The Swiss Commission admitted that the research does not conclusively prove that HIV infection during effective antiretroviral therapy is impossible. “If no transmission events were observed among 100 couples followed for two years, for instance, there might still be some such events if 10,000 couples are followed for ten years. The situation is analogous to 1986, when the statement ‘HIV cannot be transmitted by kissing’ was publicised. This statement has not been proven, but after 20 years’ experience its accuracy appears highly plausible.”

Various HIV/AIDS agencies and charities have questioned the scientific basis for the statement. Jay Levy, director of the Laboratory for Tumor and AIDS Virus Research at the University of California in San Francisco said, "Not only is (the Swiss proposal) dangerous, it's misleading and it is not considering the implications of the biological facts involved with HIV transmission".

Charlie Gilks, director of AIDS treatment and prevention at WHO stated that "We are not going to be changing in any way our very clear recommendations that people on treatment continue to practice safer sex, including protected sex with a condom, in any relationship".

Both UNAIDS and the US Center for Disease Control and Prevention (CDC) have released statements reiterating recommendations that HIV positive people should use condoms with all sexual partners regardless of whether they are receiving treatment.

For more information about HIV treatment please visit our Introduction to HIV and AIDS treatment page. 

Aidsmap, 30/01/08, Bulletin of Swiss Medicine, AFP, 31/01/08

UNAIDS statement, 01/02/08, CDC statement, 01/02/08