Re: [pronut-hiv] New Hope for HIV Mothers (2)

["Rachel Stern" <sternworks@verizon.net>]

Thanks for posting this information. It isn't clear to me what is the 
rationale for the nelfinavir in the women with >250 T cells. Also, which 
drugs are the breastfeeding women getting? The same ones they started on?

anyway, it sounds to me like women are getting their drugs daily during at 
least 6 months of breastfeeding. Is that the case? If so they are taking 3 
costly drugs (combivir is 2 drugs) for which someone is paying or 
subsidizing. For prevention of new infections in the infants, wouldn't it be 
less expensive to provide ready-to-feed formula? More importantly, are these 
very potent meds making their way into the breastmilk drunk by babies who 
are not hiv-infected, and how does that affect the babies?

Personally, I believe infected infants should get hiv drugs, and infected 
moms should also get hiv drugs, but the idea of non-infected infants 
possibly getting these 3 drugs.....That worries me.

----- "ProNut-HIV"wrote:


> New Hope for HIV Mothers
> African Woman and Child Feature Service (Nairobi)
>
> March 9, 2006
> Arthur Okwemba
> Nairobi
>
> Initial results from a study being carried out in Kisumu indicate that a
> new drug intervention could allow HIV-positive mothers to breastfeed
> their babies without infecting them.
>
> Researchers from the Centres for Disease Control of the US and Kenya
> Medical Research Institute have recruited 348 women out of an expected
> 520, but preliminary results indicate a much lower incidence of
> mother-to-child HIV transmission among the study group.
>
> "We are seeing exciting results that are likely to work for the good of
> the women. But I can't give you the detailed statistics because we have
> yet to finish analysing data," says Tim Thomas, head of HIV research at
> the Kemri research station in Kisumu.
>
> Antiretroviral drugs
>
> Studies in African countries show that when the drug Nevirapine is given
> as a single dose to HIV-positive women at the onset of labour, chances
> of a mother passing the virus to the baby are reduced from 40 to 12 per
> cent.
>
> The Kisumu study wants to reduce this figure further to six per cent,
> significantly cutting down the possibility of the child getting
> infected.
>
> To reduce mother-to-child transmission, antiretroviral drugs are
> administered at 33 weeks of pregnancy and just before the onset of
> labour.
>
> Women with CD4 counts of more than 250 are given Combivir and Nelfinavir
> while those with less than 250 are put on Combivir and Nevirapine. CD4
> stands for immunity cell count of a patient, which normally should be
> 500. If the number falls below that, you become susceptible to
> infections.
>
> Those taking the drugs continue do so for six months after delivery,
> during which they continue to exclusively breastfeed.
>
> Studies elsewhere have shown that HIV-positive mothers who exclusively
> breastfed for at least three months were less likely to infect their
> babies than those who introduced other foods and fluids during the
> period.
>
> Breastfeeding
>
> The use of drugs in the Kisumu study is designed to lower the amount of
> the virus in the woman's body and consequently reduce the risk of
> infecting the baby.
>
> After six months, mothers with a strong immunity cell count - more than
> 200 - are discontinued from both drugs and breastfeeding. But they are
> monitored for up to two years to assess the performance of their immune
> systems.
>
> Those whose cell count is still low by the end of six months are asked
> to stop breast feeding but continue taking drugs for up to two years.
>
> Babies born to these mothers are monitored to determine whether they are
> infected and, if so, they are put on medication. But once mothers are
> out of medication they are advised not to breastfeed at all and start
> the children on solid foods.
>
> But the study has had its downside: some 24 subjects have 'absconded'
> midway supposedly after being discouraged by their husbands and other
> family members. Those interviewed by the researchers cited husbands as
> being key to their decision.
>
> "Although we ask women to come along with their husbands during the
> antenatal clinics as a way of getting the support of the husband, it is
> not mandatory," says Thomas.
>
> Maternal clinics
>
> In the past, organisations that have tried to make it mandatory for
> women to be accompanied by husbands to maternal clinics have seen the
> effort backfire. Many women either stopped attending subsequent sessions
> or opted not to visit such centres at all.
>
> The researchers in the Kisumu study are nevertheless upbeat that a good
> number of the 348 women who are still participating in the study are
> accompanied by their husbands to the clinics.
>
> All in all, Thomas says the study is sensitive to recommendations by the
> US Food and Drug Administration on the use of Nevirapine following
> indications that the drug posed a high risk of damage to the liver. "We
> had seen some mild side-effects in our volunteers who were on Nevirapine
> but we have since put these on other medication," says Thomas.
>