Hi,
Does anyone know more about this study and how they determined that
"regardless of group, the infection rate then soared because mothers were
passing the virus on in their breast milk"?
Thanks,
Kathleen Fallon Pasakarnis, M.Ed. IBCLC
Breast-feeding Foils Treatment, AIDS Vaccine, Screening
AIDS Read 12(5):191,225, 2002. © 2002 Cliggott Publishing, Division of SCP
Communications
http://www.medscape.com/viewarticle/437179_print
Posted 07/26/2002
Breast-feeding Wrecks Short-Course Anti-HIV Treatment of Babies
Many African infants who are saved from HIV infection in the womb thanks to
antiretroviral drugs nevertheless contract the virus through breast-feeding,
according to a new report (Agence France Presse. April 5, 2002). The study,
published in Lancet (2002;359:1178-1186), sheds light on flaws in the
"short-course" antiretroviral treatment that is widely used in Africa for
economic reasons. The study's aim was to find the most effective way of
administering 2 common antiretrovirals, zidovudine and lamivudine.
Researchers conducted a randomized trial among 1797 pregnant women with HIV
infection in Tanzania, South Africa, and Uganda. The women were divided into
4 groups: The first group received the 2 drugs as therapy before delivery,
during labor, and after the child's birth; the second received it during
labor and after delivery; the third was given the treatment only during
labor; the fourth was given placebo. Six weeks after birth, 5.7% of newborns
in the first group had HIV infection; the rates in the other groups were
8.9%, 14.2%, and 15.3%, respectively. However, regardless of group, the
infection rate then soared because mothers were passing the virus on in their
breast milk. After 18 months, infection rates were 15%, 18%, 20%, and 22%,
respectively. The PETRA study was conducted in 1998 and sparked a fierce
debate about medical testing in developing countries, centering on the
placebo that was given to the fourth group of women. Wealthy countries
provide HIV-infected mothers with a long course of these drugs, before birth
and for many weeks afterward, when the mother is breast-feeding. However,
African countries are limited by funds and can afford only the short course
of treatment that focuses on labor and delivery. Lead researcher Joep Lange
of the University of Amsterdam said that the first treatment regimen was
clearly the most beneficial for infants at risk for contracting HIV infection
from their mothers. He recommended that a third antiretroviral agent,
commonly used in rich countries, be added to the dual-drug mix. [CDC
HIV/STD/TB Prevention News Update, Wednesday, April 10, 2002]
AIDS Vaccine Moves Ahead in Trials
An AIDS vaccine developed with the aim of getting some kind of protection
against the infection into Africa as soon as possible will move ahead into
the next phase, researchers said recently. The vaccine, being tested by the
US-based International AIDS Vaccine Initiative (IAVI), the Kenya AIDS Vaccine
Initiative, and Britain's Medical Research Council, appears to have worked
safely in the first group of volunteers, researchers said. IAVI did not
release specific data about how well the vaccine worked but said more than
half of 26 volunteers vaccinated in Britain showed a strong immune response
(Fox M. Reuters Health Information Services. April 4, 2002). "The approach is
looking really good in preliminary data," IAVI chief Dr Seth Berkeley said.
"We are saying it is good enough to move into pivotal phase 1/2 trials."IAVI
has several vaccines in the works designed to fight strains of the virus
found in Africa and other hard-hit areas. The first volunteers for the new
trial were immunized in early April in Britain. "If the results are as good
in this larger-scale trial, we will fast-track this into phase 3, and we are
talking 2 1/2 years," Berkeley said. The vaccine was developed after doctors
found a group of prostitutes in Kenya who seemed resistant to the AIDS virus.
Their immune systems were studied, and the vaccine was designed to simulate
their immune response -- eliciting the same CD8 T-cell response -- in the
hope that this will protect people against HIV. The vaccine, which is a
2-dose combination of DNA from HIV and a modified version of smallpox
vaccine, is being tested in Kenya, but results from that trial will not be
available until summer, Berkeley said. The next phase of testing will involve
100 volunteers. If this first IAVI vaccine continues to look promising,
Berkeley said, 6 other formulations the group has in the works can move into
human trials. [CDC HIV/STD/TB Prevention News Update, Friday, April 5, 2002]
Relationships of Stigma and Shame to Gonorrhea and HIV Screening
The stigma and shame associated with HIV infection and other sexually
transmitted diseases (STDs) are important barriers to appropriate diagnostic
and treatment services. Stigma and shame are related but distinct constructs.
Stigma is defined as an attribute or label that sets a person apart from
others and links the labeled person to undesirable characteristics. Shame is
defined as a negative emotion elicited when a person experiences failure in
relation to personal or social standards, feels responsible for this failure,
and believes that the failure reflects self-inadequacy rather than
inappropriate behavior. In one study, 59% of men who had never been tested
for HIV cited fear of negative social consequences as an important reason for
not seeking testing. Stigma may influence a pregnant woman's refusal to be
tested for HIV despite the benefits of treatment during pregnancy. A recent
Institute of Medicine report identified stigma as a key element of the
"hidden epidemic" of STDs in the United States. An implicit characteristic of
stigma is that it represents socially shared knowledge understood even by the
targets of the stigmatizing attitudes and behaviors. Thus, shame can be an
internalized reaction to stigma. Recent research examined the relationships
of stigma and shame with 2 types of STD-related care: a gonorrhea test during
the past year and at least 1 HIV test in the past year (Fortenberry JD,
McFarlane M, Bleakley A, et al. Am J Public Health. 2002;92:378-381).
Gonorrhea or HIV screening requires care seeking by individuals and
communication with clinicians that may be affected by stigma, shame, or both.
In both gonorrhea and HIV infection, screening provides an opportunity for
risk-reduction interventions among those who are not infected. Among those
who are infected, effective treatment and control strategies can reduce the
risk of sequelae and limit transmission to others. STD/HIV-related care
therefore could be improved through a better understanding of factors such as
stigma and shame that may act as barriers to appropriate screening. [CDC
HIV/STD/TB Prevention News Update, Thursday, April 4, 2002]
Off the Wires is compiled by Ned E. Heltzer, RPh, MS, from various wire
service reports. Mr Heltzer is drug management consultant for Management
Sciences for Health, Arlington, Va.
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