Eradicating new infant HIV infections in Zimbabwe will
require improved access to antiretroviral medications and support to help
HIV-infected mothers continue taking their medication, according to a report
published in the January issue of PLoS Medicine.
Pediatric HIV infection has been nearly eliminated
in resource-rich settings, such as the United States and Europe, through a
combination of anti-HIV drugs and avoidance of breast-feeding, Andrea
Ciaranello, MD, MPH, of the Massachusetts General Hospital division of
infectious diseases, said in a press release. The World Health
Organization has urged health programs throughout the world to aim for the same
successes, calling for the virtual elimination defined as
reducing transmission risk to less than 5% of mother-to-child HIV
An international research team investigated uptake of
prevention of Zimbabwean mother-to-child HIV transmission services, infant
feeding recommendations and specific drug regimens using a computer model to
simulate two populations of HIV-infected pregnant/breast-feeding women (mean
age, 24 years).
The researchers compared the current Zimbabwean
prevention program, which provides three-drug antiretroviral therapy to
pregnant women with advanced HIV infection and a single dose of the antiviral
drug nevirapine for all others, with two updated antiviral options recommended
by WHO in 2010.
The first option recommended by WHO guidelines involved
zidovudine in pregnancy, infant nevirapine throughout breast-feeding for women
without advanced disease and lifelong combination ART for women with advanced
disease. The second WHO option included pregnancy/breast-feedinglimited
combination antiretroviral drug regimens without advanced disease and lifelong
ART with advanced disease.
Researchers examined the proportion of pregnant women
accessing and adhering to prevention of mother-to-child HIV transmission
services and reported rates of 36% in 2008 and 56% in 2009 vs. target goals of
80% in 2008 and 95% in 2009. The 2009 single-dose nevirapine-based Zimbabwean
prevention program led to a projected transmission rate of 18%, an improvement
from 20.3% the previous year.
According to the report, if single-dose nevirapine was
replaced by more effective regimens, with 2009 (56%) uptake, estimated
mother-to-child transmission risk would be 14.4% (with zidovudine) or 13.4%
(with combination antiretroviral drug regimens). However, even with 95% uptake
of more effective regimens, projected transmission risks (6.1%-7.7%) would
exceed the WHO goal of less than 5%.
Disclosure: The researchers report no relevant