CROI: What We Learned in Boston about Fighting Pediatric AIDS
Dr. Jeffrey Safrit
Los Angeles, California
March 9, 2011
Last week I attended the 18th Conference on Retroviruses and Opportunistic Infections
, otherwise known as CROI
, in Boston.
The conference is the largest North American gathering of scientists and clinicians working on HIV/AIDS and related viruses, and research findings presented over the past 18 years have revolutionized how we fight this disease.
More recently, we’ve seen some amazing advances in prevention research:
Arguably, one of the greatest prevention success stories in AIDS research is the ability to prevent almost all cases of transmission of HIV from a mother to her baby. This was discovered in the 1990s by using antiretroviral medicines for HIV-positive women during pregnancy, and for their infants following birth (PACTG 076 study
). In just a few short years in the U.S. and other developed countries, we virtually eliminated all new cases of pediatric HIV.
The most important task now for us at the Elizabeth Glaser Pediatric AIDS Foundation and our family of researchers
is to bring that scientific success story to other parts of the world. In sub-Saharan Africa and other resource-poor settings, there are more than 1,000 children infected with HIV every day – almost all of those cases preventable.
Several interesting studies presented at CROI this week gave us more hope on how to protect these children and their mothers from HIV, and ultimately eliminate pediatric AIDS worldwide. I’ve highlighted a few of the most significant studies below:
One study – HPTN 040
– addressed how to help those women who don’t discover they are HIV-positive until they are in labor, which is a common occurrence for women in Africa who often can’t make it to clinics for prenatal care. In this study, the risk of HIV transmission to their babies was cut in half by adding one or two other drugs to the standard post-birth drug regimen administered to infants, usually six weeks of the drug AZT.
Another study – HPTN 046
– examined how to best prevent transmission of HIV during breastfeeding, the critical next step to stopping mother-to-child transmission in sub-Saharan Africa and other regions. In developed countries, HIV-positive women are advised to formula feed their infants to ensure that they don’t transmit HIV through breast milk, which is how Elizabeth Glaser unknowingly passed HIV to her daughter Ariel.
But in resource-poor settings, formula feeding is often not a viable alternative because of lack of clean water, lack of access to formula, or the high cost of that formula. In these settings, previous studies have shown that babies of HIV-positive women who avoid breastfeeding die from other diseases, brought about by factors such as unsafe water, lack of protective antibodies or adequate nutrition from breast milk, and other causes. Thus, the WHO recommends exclusive breastfeeding for these mothers as the best method of HIV-free survival for their babies.
In the HPTN 046 study, researchers were able to cut in half the number of HIV infections during breastfeeding by giving the infant the antiretroviral drug nevirapine for six months following birth. If the mothers also received antiretroviral drugs for their own health, HIV transmission was reduced to nearly zero – our ultimate goal.
And finally, the IMPAACT P1060
study looked at how to reduce the development of nevirapine resistance in HIV-infected infants. While administering a single dose of nevirapine to mother and baby is a cheap and simple way to reduce by half the risk of HIV transmission, the virus can also become resistant to nevirapine very easily. If the child is born with HIV, this could complicate treatment options later in life. The IMPAACT study showed that substituting or adding a more potent drug to the dose of nevirapine significantly reduced the number of HIV-positive infants who fail therapy, most likely because of this drug resistance.
In summation, this week in Boston we learned more ways to keep infants HIV-free, and more treatment options for those who are already infected. It was a good week for children.
Jeffrey T. Safrit, Ph.D, is the Director of Clinical and Basic Research for the Foundation, based in Los Angeles.