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Mother-to-Child HIV Transmission Rate Falling, but More Can Be Done

January 28, 2011

Transmission of HIV to children before or at birth has dropped dramatically around the country in the last decade since the advent of powerful new therapies. That certainly is true for Florida, where each year, fewer than 10 babies are born with the disease despite the fact that more than 600 HIV-positive women each year, on average, give birth.

Still, more can be done to even further reduce the number of babies born with the disease, say pediatric HIV experts at the University of Florida who presented their work during the 18th International AIDS conference in Vienna, Austria.

"This is one of those diseases for which we learned how to prevent transmission. We need to make full use of this method and our energies need to be focused on the effort," said lead researcher Dr. Mobeen Rathore, a professor and chief of pediatric infectious diseases and immunology at the University of Florida College of Medicine-Jacksonville, and director of the UF Center for HIV/AIDS Research, Education and Service.

Around the United States, the decreasing number of pediatric infections is a direct result of the advent of powerful anti-HIV therapies in the mid-1990s and the establishment of protocols by the Centers for Disease Control and Prevention to treat pregnant women who are infected, and their babies.

Increased HIV-testing outreach and education efforts have also paid off. And CDC guidelines for "opt-out" HIV-testing for pregnant women mean testing is a routine part of their care, and women would have to specifically decline it. Rapid testing during labor and delivery gives one last chance to administer therapies that can prevent transmission.

In Florida, the Targeted Outreach for Pregnant Women Act of 1998 was enacted to help improve prenatal care and reduce the number of babies with HIV or prenatal drug exposure.

After New York, Florida has the second highest number of babies born to HIV-positive women. The state began monitoring the number of HIV-exposed babies in 2006. Up to 2008, a total of 2,374 cases of pediatric HIV/AIDS have been reported in Florida. So far this year, just one case has been reported.

"The reduction of mother-to-child HIV transmission is one of the biggest success stories of the HIV epidemic," said Thomas Liberti, chief of the bureau of HIV/AIDS in the Florida Department of Health. "The question is, 'How low can we go?'"

The UF researchers teamed with colleagues in the Florida Department of Health Perinatal Prevention Division to review pediatric HIV data for the period from 2002-09, and found 102 cases.

Despite the many effective measures in place to help prevent HIV-transmission to babies, there are missed opportunities, the researchers found.

Mothers of half of the infected babies tested positive for HIV before becoming pregnant. But some refused or neglected to take the medications that could have kept their babies HIV-free. Some had no prenatal care, and so did not receive available treatments.

Some women were HIV-negative at the start of their pregnancy, but became infected afterward. Others were diagnosed with HIV only after the birth of their babies. Repeat testing during pregnancy and rapid testing during labor and delivery would have alerted health care providers.

The study shows that for some women, the issue might not be a lack of availability of medical services. Mental illness, intravenous drug use and incarceration and other risk factors associated with increased risk of HIV infection affected about one-third of the women who delivered infected babies. Mental health and substance abuse issues often prevent women from taking advantage of medical care or adhering to a treatment regimen prescribed by their physicians.

Finding creative ways to address issues such as the shortage of mental health-care providers will help women and their babies get needed care, the researchers said.

The health department has already begun discussions with the Centers for Disease Control and Prevention to discuss steps that can be taken to further reduce mother to child HIV transmission.

"Many of our patients have mental health and other life issues, so if we do not address them, the treatment protocol will not be effective," Rathore said. "This is an intervention that has the opportunity to work better."

Story Source:

    The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Florida, via EurekAlert!, a service of AAAS.


Tags: Mother-to-child, HIV rate

HIV Virus Hides In The Brain

January 12, 2011

Studies of the spinal fluid of patients given anti-HIV drugs have resulted in new findings suggesting that the brain can act as a hiding place for the HIV virus. Around 10% of patients showed traces of the virus in their spinal fluid but not in their blood a larger proportion than previously realised, reveals a thesis from the University of Gothenburg, Sweden.

We now have effective anti-HIV drugs that can stop the immune system from being compromised and prevent AIDS. Although these drugs effectively prevent the virus from multiplying, the HIV virus also infects the brain and can cause damage if the infection is not treated.

"Antiviral treatment in the brain is complicated by a number of factors, partly because it is surrounded by a protective barrier that affects how well medicines get in," says Arvid Edén, doctor and researcher at the Institute of Biomedicine at the Sahlgrenska Academy. "This means that the brain can act as a reservoir where treatment of the virus may be less effective."

The thesis includes a study of 15 patients who had been effectively medicated for several years. 60% of them showed signs of inflammation in their spinal fluid, albeit at lower levels than without treatment.

"In another study of around 70 patients who had also received anti-HIV drugs, we found HIV in the spinal fluid of around 10% of the patients, even though the virus was not measurable in the blood, which is a significantly higher proportion than previously realised," explains Edén.

The results of both studies would suggest that current HIV treatment cannot entirely suppress the effects of the virus in the brain, although it is not clear whether the residual inflammation or small quantities of virus in the spinal fluid in some of the patients entail a risk of future complications.

"In my opinion, we need to take into account the effects in the brain when developing new drugs and treatment strategies for HIV infection," says Edén.

HIV

HIV, human immunodeficiency virus, belongs to the retrovirus family and takes two forms, HIV-1 and HIV-2, which can be transmitted through blood, semen and other secretions and bodily fluids. In the acute phase, patients suffer from fever, swollen lymph glands and rashes. These symptoms do recede, but AIDS develops after a long period of infection. Attempts to produce an HIV vaccine have been ongoing since the 1980s, but have yet to be successful.

Source: University of Gothenburg


Tags: Mother-to-child, HIV rate

A Third Of HIV Patients Diagnosed Late, UK

January 01, 2011

A third of adults diagnosed with HIV in the UK last year were diagnosed late, according to figures released today by the Health Protection Agency.

In 2008 there were 7,298 new diagnoses of HIV in the UK with an estimated 32% (2,310) of adults over 15 years being diagnosed at a point after which treatment should already have begun (CD4 cell count <200 per mm3). This results in patients missing out on the benefits that come from early diagnosis, including improved life expectancy.

According to British HIV Association guidelines introduced last year, patients with HIV should now be considered for treatment when their CD4 cell count reaches <350 per mm3 rather than waiting until it falls further to <200 per mm3. If these guidelines were used when interpreting the latest figures, it would mean more than half (55%) of all individuals diagnosed last year would have been diagnosed late.

The number of deaths among HIV-infected people has remained stable over the past decade. However, three quarters of the 525 people with HIV who died in 2008 had been diagnosed at a point after which treatment should have begun according to the latest treatment guidelines (i.e. a CD4 cell count <350 per mm3). This highlights the importance of promoting testing to ensure early diagnosis and enable successful treatment.

The agency's annual HIV report also shows that the number of people living with HIV in the UK increased to 83,000 in 2008. This number will continue to rise as people with HIV live longer on effective therapy.

Improvements have been made in the number of people testing for HIV - 100,000 more tests were performed at GUM (genitor-urinary medicine) clinics in 2008 than the previous year (950,000 up from 850,000 in 2007). 93% of people attending GUM clinics are now tested for HIV. This has continued to increase steadily since 2004 when 23% of visitors to a GUM clinic were not being tested for the infection.

National HIV testing guidelines recommend wider HIV testing in those areas of the country where the prevalence of diagnosed HIV infection is greater than 2 per 1,000 population aged 15 to 59 years. There are 43 local authorities in England (35 Primary Care Trusts) where the prevalence of HIV is above this threshold. It is in these areas that health professionals should routinely offer HIV testing to all men and women aged 15 to 59 years who are registering in general practice or admitted for medical care.

Dr Valerie Delpech, an expert in HIV from the Health Protection Agency said: "HIV is a serious infection but if diagnosed early, there are very good treatment options. Of concern is that over 22,000 people remain unaware of their infection in the UK and cannot therefore benefit from effective treatment.

"It is encouraging to see the increased numbers of HIV tests being performed in STI clinics. However, we must reduce the number of people presenting late with their infection by increasing awareness of the importance of testing, improving access and de-stigmatising the HIV test.

"We need to continually reinforce the safe sex message - using a condom with all new or casual sexual partners is the surest way to ensure you do not become infected with a serious sexually transmitted infection such as HIV.

"People need to know that testing for HIV and all sexually transmitted infections is both free and confidential at sexual health clinics across the UK. If you have had unprotected sex with a new or casual partner you should go and get tested.

"Medical guidelines published last year have encouraged more widespread testing in areas where there is a high prevalence of diagnosed HIV and we hope this will contribute to improving awareness of the infection in this community and therefore increase testing."

2008 in numbers

Living with HIV

-- An estimated 83,000 people are living with HIV in the UK (both diagnosed and undiagnosed).
-- This equates to a rate of 1.3 people per 1,000 population.
-- Among the 83,000 HIV infected individuals, 27 per cent (22,400) remain unaware of their infection.

Accessing care

-- 61,213 people diagnosed with HIV were accessing care in the UK last year - this represents and eight per cent increase in 2007 (56,433) and more than 3x the number in1999 (20,009).

New diagnoses

-- 2008 saw 7,298 new diagnoses of HIV, a similarly high figure to recent years, although a decline on the peak observed in 2005 (7,975).
- 38% (2,760) were among gay men and four out of every five probably acquired their infections in the UK.
- 58% (4,220) were acquired through heterosexual contact - with the majority of cases probably infected abroad. Total diagnoses among heterosexuals have declined from their peak in 2004 (5,020) although those acquired within the UK are increasing from an estimated 740 in 2004 to 1,130 in 2008.
- 170 infections were acquired through injecting drug use.
- 110 were acquired through mother-to-child transmission.

Late diagnoses

-- An estimated 32% (2,310/7,218) of adults aged over 15 years were diagnosed with a CD4 cell count <200 per mm3 within three months of diagnosis. The proportion diagnosed with a CD4 cell count <350 per mm3 (the threshold at which treatment should be considered according to 2008 British HIV Association guidelines) was 55% (3,970/ 7,218).

Death

-- 525 deaths (387 men and 138 women) were recorded among HIV-infected people in 2008.

* Adjustments have been made to some of the detailed figures provided above to take into account missing information relating to the cases reported

Notes

To view HPA's annual HIV report - HIV in the United Kingdom: 2009 Report visit the agency's website at http://www.hpa.org.uk/HPA/Publications/InfectiousDiseases/HIVAndSTIs/

Late diagnosis is defined as having evidence of substantially reduced immunity assessed by a laboratory measure of a CD4 count of <200cells/mm3 or an AIDS diagnosis at the time of an HIV diagnosis. For more information about this visit here.

A high prevalence of HIV is considered to be areas where diagnosed HIV prevalence in the local population exceeds 2 in 1,000.

Source
Health Protection Agency



Tags: Mother-to-child, HIV rate


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