The AIDS Beacon™

A clinical trial conducted by the World Health Organization (WHO) shows that a pregnant woman taking a new triple-drug therapy continued six months postpartum significantly reduces the chance that she passes the HIV virus on to her infant, known as mother-to-child transmission.

These results were presented at the Fifth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention held in Cape Town, South Africa on July 19-22.

Preventing mother-to-child transmission is a major focus of organizations combating the AIDS pandemic. Without treatment, 15-30 percent of infants contract the virus during pregnancy and delivery and an additional 5-10 percent are infected during breastfeeding. However, in underdeveloped countries, formula-feeding is not a viable option.

Although buying powdered formula and mixing it with clean water is a realistic alternative to breastfeeding for women in more developed countries, this is not the case with many women in developing nations. Even if a woman can afford to buy formula, it is not guaranteed that the water is free of diarrhea-causing microbes. These microbes are a serious threat—diarrhea is the second leading cause of death in children under five years of age worldwide.

The study, entitled “Kesho Bora”, meaning ‘a better future’ in Swahili, promises just that. With current WHO treatment guidelines (used as a control group in the study), the HIV virus spread to 9.5 percent of children after one year, but with the new drug regimen tested in the study, this percentage was significantly reduced to 5.5 percent, a 42 percent decrease.

The Kesho Bora study was conducted between June 2005 and August 2008 and included 1,140 women at five different sites in Burkina Faso, Kenya, and South Africa. It compared the effects of the standard short course of antiretroviral drugs that concludes at delivery to a new combination therapy of three drugs, Retrovir (zidovudine), Epivir (lamivudine), and Kaletra (lopinavir/ritonavir), starting in late pregnancy until six months into breastfeeding.

This recent research makes breastfeeding a safer option. Breastfeeding is more beneficial to infants, since it provides them with antibodies that protect against diarrhea, malnutrition, and other potentially deadly illnesses. As the Kesho Bora study demonstrates, mothers need to continue taking this combination for at least six months after giving birth and probably longer if they continue to breastfeed to provide the best protection against HIV transmission.

However, for women to benefit from the new drug regimen, they need to have access to antiretrovirals for an extended period of time, which is difficult for many women in underdeveloped countries.

Dr. Judith Graeff, a Communication Development Specialist for UNICEF, said, “The study did not address what extent women in less developed countries will have access to the drugs for the duration of treatment. The ability of many governments in less developed countries to assure a reliable supply of drugs at little or no cost to those who need them is always a question.”

Although the findings of this study offer a more hopeful future for preventing mother-to-child transmission and the spread of the AIDS pandemic, HIV-positive mothers would be able to benefit from this new drug regimen only if their local heath services are able to provide a dependable source of affordable antiretrovirals.

Graeff said, “The results must be weighed against the living conditions of the women affected by AIDS. To what extent are their lives amenable to following the regimen recommended by WHO correctly enough for it to be effective?”

Improving health services and living conditions in underdeveloped countries will be significant in order for this antiretroviral regimen to be a realistic alternative for women with HIV.

To read the Kesho Bora study, please see the WHO Web site.