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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