Pregnant women who are unaware they have HIV miss the chance for drug treatment that not only can benefit their own health but could also prevent them from transmitting the virus to their infants.
When HIV is not diagnosed until women go into labor, their infants are usually treated soon after birth with the anti-HIV drug zidovudine (ZDV) to prevent them from becoming infected with the virus.
Now, a National Institutes of Health study has found that adding one or two drugs to the standard ZDV treatment can reduce the chances by more than 50 percent that an infant will develop an HIV infection. The study results were presented March 2 at the 18th Conference on Retroviruses and Opportunistic Infections, in Boston.
The study was conducted at 19 research hospitals in Brazil, South Africa, Argentina and the United States, under contract to the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). Additional funding was provided by the NIH's National Institute of Allergy and Infectious Diseases.
An estimated one-fifth of people in the U.S. who have HIV are unaware they harbor the virus. From 100 to 200 infants are born with HIV in the U.S. each year, many to women who either were not tested in early pregnancy or who did not receive treatment during pregnancy. Internationally, estimates of HIV testing vary, with only 21 percent of pregnant women in low- and middle-income countries having been tested during pregnancy.
"To reduce mother-to-child HIV transmission, it's best to begin antiretroviral treatment during pregnancy," said Dr. Heather Watts, a medical officer in the NICHD's Pediatric, Adolescent and Maternal AIDS Branch and an author of the study. "However, when treatment during pregnancy isn't possible, our results show that adding one or two drugs to the current regimen provides another important means to reduce the chance for mother-to-child HIV transmission."
The NICHD/HIV Prevention Trials Network 040 study evaluated 1,684 infants born to women whose HIV infections were not diagnosed until they were in labor. The infants were randomly assigned to three groups: those receiving the standard six weeks of therapy with ZDV; those receiving six weeks of ZDV plus three doses of nevirapine (NVP) during the first week of life; and those receiving six weeks of ZDV plus two weeks of lamivudine (3TC) and nelfinavir (NFV). The study results showed that treatment with the two- and three-drug regimens reduced HIV transmission by more than 50 percent.
Proportion with HIV infection at 3 months
"Our results showed conclusively that the two- and three-drug regimens are superior to the standard treatment with zidovudine," said the study's chair, Dr. Karin Nielsen-Saines, a clinical professor of pediatrics in the division of infectious diseases at the David Geffen School of Medicine at UCLA and a member of the UCLA AIDS Institute.
Other authors of the study were Valdilea Gonçalves Veloso of the Fiocruz Institute in Rio de Janeiro, Brazil; Yvonne J. Bryson of UCLA; Esau C. Joao of Servants of the State Hospital in Rio de Janeiro; Jose Henrique Pilotto of the General Hospital of Nova Iguacu in Nova Iguacu, Brazil; Glenda Gray of Chris Hani Baragwanath Hospital in Johannesburg, South Africa; Gerhard Theron of Tygerberg Hospital in Capetown, South Africa; James Bethel of Westat Inc. in Rockville, Md.; and Lynne Mofenson of the NICHD.
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) sponsors research on development, before and after birth; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation.
The National Institutes of Health (NIH), the nation's medical research agency, includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments and cures for both common and rare diseases.
The UCLA AIDS Institute, established in 1992, is a multidisciplinary think tank drawing on the skills of top-flight researchers in the worldwide fight against HIV and AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social sciences, public health, nursing and disease prevention. Their findings have led to advances in treating HIV, as well as other diseases, such as hepatitis B and C, influenza and cancer.