Studies Find That Vitamin A Increases The Amount Of HIV In Breast Milk – Researchers at the University of Michigan School of Public Health have found that vitamin A and beta-carotene supplements are not safe in HIV-positive women who are breastfeeding because they may increase the amount of HIV in breast milk, raising the risk of transmitting HIV to the baby. The researchers think the supplements may increase the risk of breast inflammation, which can allow small amounts of blood to leak into the milk. Breastfeeding is not recommended for women with HIV in the United States, but is recommended in places where clean drinking water is scarce as long as women are receiving antiretroviral therapy. For more information, please visit the University of Michigan website.

Coalition For A National AIDS Strategy To Host Webinars On The National HIV/AIDS Strategy – The Coalition for a National AIDS Strategy will host two identical webinars to provide more details about implementation of the National HIV/AIDS Strategy, which was introduced by President Obama on July 13. The presenters will cover the important aspects of the Strategy, current efforts in implementation, and the need for community advocacy. The 90 minute webinars will be held on Thursday, September 2 at 1 p.m. EST and Tuesday, September 7 at 6 p.m. EST. For more information, please visit the AIDS.gov website.

Despite significant progress in other areas of the HIV/AIDS epidemic, studies are still reporting the majority of new perinatal infections to be among African Americans, seconded by Hispanics/Latinos.

This statistic is reflected in the latest data on perinatal HIV infections from 2004 to 2007. The CDC reports that 69 percent of all new infections were among African Americans, and 16 percent among Hispanics or Latinos, together making up a total of 85 percent.

These disparities can be traced to the behavior of expectant mothers in terms of their prenatal care and antiretroviral therapy choices. A previous study found that from 1995 to 1997, African American and Hispanic/Latino women were less likely than Caucasian women to initiate prenatal care during the first trimester and to carry out the appropriate number of prenatal care visits.

In another study that took place from 1997 to 2000, African American and Hispanic/Latino women were found to be less likely to engage in antiretroviral therapy prior to pregnancy.

However, the CDC’s report also contains appreciably good news: since 1991, the total number of new perinatal HIV infections annually in the United States has decreased by 90 percent. This number continues to decrease each year.

To promote this trend, there are several recommended methods to decrease the likelihood of mother-to-child transmission.

Pregnant HIV-positive women should ideally be diagnosed prior to or early on in their pregnancy, receive prenatal care, and utilize an antiretroviral therapy regimen during the pregnancy, labor, and delivery. If viral suppression has not been obtained at 38 weeks’ gestation, a caesarean section is recommended at that point.

Despite these recommendations, the best way to reduce the perinatal HIV infection rate and its associated disparities is to reduce the incidence of infection among women, particularly among those of African American or Hispanic ethnicity.

More information can be found in the CDC Morbidity and Mortality Weekly Report.

“These new recommendations are based on the most up to date, available data,” said Dr. Hiroki Nakatani, WHO Assistant Director General for HIV/AIDS, tuberculosis (TB), Malaria and Neglected Tropical Diseases, in a WHO press release. “Their widespread adoption will enable many more people in high-burden areas to live longer and healthier lives.”

The 2009 recommendations replace those previously drafted in 2006.

In 2006 patients were advised to begin antiretroviral treatment (ART) after the onset of HIV symptoms or when their CD4 (white blood cell) count dropped below 200 cells per microliter.

However the new recommendations have increased this threshold number to 350 cells per microliter regardless of symptoms or pregnancy.

Earlier onset of treatment will lower risk of HIV and TB transmission, boost patients’ immune systems, and lessen the risk of HIV-related death and disease.

The drug stavudine (Zerit) has been found to have long-term irreversible side effects such as peripheral neuropathy, a nerve disorder; and lipoatrophy, characterized by fat loss in certain areas of the body.

Therefore the WHO recommends that stavudine be phased out of treatment regimens, and replaced with less toxic and equally effective drugs such as Viread (tenofovir) and zidovudine (Retrovir).

Currently, stavudine is frequently used in developing countries as a first-line therapy due to its low cost, widespread availability, limited need for laboratory monitoring, and initial tolerability by the body.

The latest recommendations also include new strategies to reduce mother-to-child transmission and improve child survival. It is now recommended that HIV-positive pregnant women begin ART at 14 weeks, rather than the previously recommended 28 weeks.

Additionally in 2006, there was insufficient information regarding the effects of ART drug use during breastfeeding.

Newer studies have since shown that ART should continue throughout the breastfeeding period, until the baby is 12 months old. As long as the mother is receiving antiretroviral drugs, the infant will have a decreased risk of acquiring HIV as well as a greater chance of survival.

This is welcomed news, for in some cases, breastfeeding is necessary due to financial and environmental constraints. Also some cultures regard breastfeeding as the only acceptable way to nourish an infant.

Now under the 2009 recommendations the benefits of breastfeeding are not restricted to babies with HIV-uninfected mothers.

“In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to antiretroviral drugs,” said Daisy Mafubelu, the WHO Assistant Director General for Family and Community Health, in the November 30 press release.

With widespread use of these new mother-to-child guidelines, the WHO expects to see mother-to-child HIV transmission risk decrease from 32 percent to five percent or lower.

The 32 percent comes from a 2005 report by the Centers For Disease Control (CDC) describing the estimated transmission risk for mothers who went without ART and opted to breastfeed.

Lastly, in the new recommendations the WHO stresses the need for increased laboratory monitoring and greater access to CD4 testing. However, ART should not be denied in cases where monitoring tests are not available.

Nevertheless there are several obstacles to the implementation of the recommendations – most notably limited access to and availability of treatments in developing countries.

The 2009 “Towards Universal Access” report released by the WHO, UNICEF, and UNAIDS reported that more than four million people had access to ART in low- and middle-income countries by the end of 2008.

Though this is a tenfold increase from five years prior, it still only represents 42 percent of the estimated 9.5 million people in need of treatment in 2008.

So far the WHO has released three sets of “Rapid Advice” documents addressing new recommendations for adults and adolescents, pregnant women and infants, and infant feeding.

The full guidelines are expected to be released in 2010.

For more information, please see the WHO “Rapid Advice” recommendations or the November 30 WHO press release. More on prevention of mother-to-child transmission can be found at the related AIDS Beacon article.