Half of HIV-exposed babies in parts of Africa not receiving available HIV prevention

BIRMINGHAM, Ala. – In the ongoing battle to prevent mother-to-child transmission of human immunodeficiency virus (HIV), not all weapons are being used: Only about half of HIV-exposed infants in some African countries received a minimal dose of the prevention drug nevirapine, say researchers at the University of Alabama at Birmingham.

In a July 21, 2010 issue of the Journal of the American Medical Association, the researchers report that only 51 percent of HIV-exposed infants received the minimal regimen of nevirapine to protect them. As for women who had been prescribed nevirapine before birth, the study found that many had no sign of the prevention drug in their umbilical cord samples – which limits mother-to-child HIV prevention efforts, says Elizabeth Stringer, M.D., UAB associate professor of obstetrics and gynecology and the lead author of the study in the JAMA HIV/AIDS theme issue.

"What this study shows us is that there are programmatic failures and common problems that occur along the path to mother-to-child transmission prevention," including HIV testing inadequacies and patients not taking their medications, says Stringer, who treats patients and conducts research full-time at the UAB-affiliated Center for Infectious Disease Research in Zambia along with her husband, UAB's Jeffrey Stringer, M.D., who directs the Zambian center. Both are members of UAB's Center for AIDS Research.

"We know that true mother-to-child transmission prevention begins with HIV testing, with finding those who are infected and getting them into a program helps them adhere to the single-dose nevirapine and other care guidelines," Stringer says.

The study is based on cord samples from 27,893 mother-infant pairs treated at clinics in the African countries of Cameroon, Cote d'Ivoire, South Africa and Zambia. The samples are from 43 separate clinics were single-dose nevirapine is used to prevent mother-to-child transmission, along with additional prophylaxis drugs. Complete data for cord-blood results included 3,196 HIV-seropositive mother-infant pairs.

Last year, the World Health Organization revised its international guidelines to standardize drug regimens that prevent mother-to-child HIV transmission. Nevirapine continues to be the backbone of anti-HIV therapy in the developing world, but its usefulness is limited by how many infected and at-risk persons receive the drug.

The UAB study underscores the need to expand programs that strive for global pediatric AIDS control, and to incorporate ongoing monitoring and quality-improvements into all nevirapine-based care programs. More than 30 million people globally are infected with HIV; it leads to more than 2 million AIDS-related deaths each year.

The research is a collaboration among many partners: UAB; the U.S. Centers for Disease Control and Prevention Division of HIV/AIDS Prevention and Global AIDS Program; Centers for Infectious Disease Research in Lusaka, Zambia; Cameroon Baptist Convention Health Board; Elizabeth Glaser Pediatric AIDS Foundation; Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast; University of Bordeaux; and University of Cape Town. Funding support for the study is provided by the CDC.

The UAB Department of Obstetrics and Gynecology provides comprehensive care for every stage of life — from routine gynecologic care, to childbirth, to menopause and beyond. Its physicians are leaders in their fields in a nationally ranked program dedicated to giving patients the best care available.

The UAB Center for AIDS Research (CFAR) is one of the seven original centers established in 1988 by the federal government to stimulate research and advances in fighting AIDS and HIV. CFAR supports prevention and HIV-patient care at the 1917 Clinic and in Africa through a partnership with the Center for Infectious Disease Research in Zambia.