Eliminating Pediatric HIV/AIDS, and Caring for Children with HIV<br />Dr. Laura Guay<br />Vice President of Research<br />...
Elizabeth Glaser<br />
Ariel and Jake Glaser<br />
The Elizabeth Glaser Pediatric AIDS Foundation - 1988<br />
HIV Disease Course<br />
Diagnosis of HIV<br /><ul><li>HIV antibody tests
When exposed to HIV (or any infection) the body makes antibodies to fight the infection
Standard HIV tests measure these antibodies (EIA, rapid tests, western blot)
HIV antibodies from an HIV-infected woman cross the placenta and enter the baby’s blood
HIV detection tests
These tests measure the actual parts of the HIV virus itself (PCR, p24 antigen, viral culture)
These tests can identify HIV infection in a very young baby</li></li></ul><li>WHO’s 4-Component Strategy for MTCT Preventi...
600 000<br />500 000<br />400 000<br />300 000<br />200 000<br />100 000<br />0<br />1990<br />1991<br />1992<br />1993<br...
Provision of Antiretroviral Drugs,<br />2004-2009<br />WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 200...
Review of Latest Data - 2009 <br />  New Global HIV Infections among Children: <br />    370,000 children were infected wi...
Benefits of Global Expansion of PMTCT Programs<br /><ul><li>Provides opportunity for primary prevention for large number o...
Provides opportunity for prevention of HIV infection in children
Provides opportunity for entry point into HIV Care for large number of HIV-infected women and their infected infants
However, this is often a missed opportunity as ongoing HIV care and treatment is not available</li></li></ul><li>If women ...
Timing of HIV transmission to the infant<br />During pregnancyAround labor/deliveryDuring Breastfeeding<br />
If women and newborns take 1 dose of the drug nevirapine around the time the baby is born -<br />- only ~16 out of 100 bab...
If women and newborns take a combination of HIV drugs during pregnancy and after delivery -<br />- as few as 4-6 out of 10...
Breast Feeding vs Bottle Feeding<br />
2010 Revised WHO Guidelines<br />
Key Changes in 2010 Revised <br />WHO guidelines<br /><ul><li>Begin ART at CD4 cell count of 350 rather than 200
Start ARV prophylaxis earlier in pregnancy
Provide ARV prophylaxis during breastfeeding
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Eliminating Pediatric HIV/AIDS and Caring for Children with HIV

  1. 1. Eliminating Pediatric HIV/AIDS, and Caring for Children with HIV<br />Dr. Laura Guay<br />Vice President of Research<br />Elizabeth Glaser Pediatric AIDS Foundation<br />IAS 2011 Media Training & Briefing<br />July 16, 2011<br />Rome, Italy<br />
  2. 2. Elizabeth Glaser<br />
  3. 3. Ariel and Jake Glaser<br />
  4. 4. The Elizabeth Glaser Pediatric AIDS Foundation - 1988<br />
  5. 5. HIV Disease Course<br />
  6. 6. Diagnosis of HIV<br /><ul><li>HIV antibody tests
  7. 7. When exposed to HIV (or any infection) the body makes antibodies to fight the infection
  8. 8. Standard HIV tests measure these antibodies (EIA, rapid tests, western blot)
  9. 9. HIV antibodies from an HIV-infected woman cross the placenta and enter the baby’s blood
  10. 10. HIV detection tests
  11. 11. These tests measure the actual parts of the HIV virus itself (PCR, p24 antigen, viral culture)
  12. 12. These tests can identify HIV infection in a very young baby</li></li></ul><li>WHO’s 4-Component Strategy for MTCT Prevention<br />Prevention of HIV in women, especially young women<br />Prevention of unintended pregnancies in HIV-infected women<br />Prevention of transmission from an HIV- infected woman to her infant<br />Support for HIV-infected women, their infants, and families<br />Component<br />1<br />Component<br />2<br />Component<br />3<br />Component<br />4<br />
  13. 13.
  14. 14. 600 000<br />500 000<br />400 000<br />300 000<br />200 000<br />100 000<br />0<br />1990<br />1991<br />1992<br />1993<br />1994<br />1995<br />1996<br />1997<br />1998<br />1999<br />2000<br />2001<br />2002<br />2003<br />2004<br />2005<br />2006<br />2007<br />Year<br />This bar indicates the range<br />New Global HIV Infections among Children, 1990–2007<br />
  15. 15. Provision of Antiretroviral Drugs,<br />2004-2009<br />WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009<br />
  16. 16. Review of Latest Data - 2009 <br /> New Global HIV Infections among Children: <br /> 370,000 children were infected with HIV – <br /> More than 1,000 children EVERY DAY<br />Provision of Antiretroviral Drugs:<br /> 53 % of pregnant women living with HIV received ARVs - 47% did NOT<br /> 35% of infants born to pregnant women living with HIV received ARVs – 65% did NOT<br />
  17. 17. Benefits of Global Expansion of PMTCT Programs<br /><ul><li>Provides opportunity for primary prevention for large number of identified HIV-uninfected women
  18. 18. Provides opportunity for prevention of HIV infection in children
  19. 19. Provides opportunity for entry point into HIV Care for large number of HIV-infected women and their infected infants
  20. 20. However, this is often a missed opportunity as ongoing HIV care and treatment is not available</li></li></ul><li>If women with HIV do not take any HIV drugs during pregnancy and they breastfeed -<br />- about 30 out of 100 babies born to these women will get HIV.<br />
  21. 21. Timing of HIV transmission to the infant<br />During pregnancyAround labor/deliveryDuring Breastfeeding<br />
  22. 22. If women and newborns take 1 dose of the drug nevirapine around the time the baby is born -<br />- only ~16 out of 100 babies will getHIV from their mothers.<br />
  23. 23. If women and newborns take a combination of HIV drugs during pregnancy and after delivery -<br />- as few as 4-6 out of 100 babies will get HIV from their mothers.<br />
  24. 24. Breast Feeding vs Bottle Feeding<br />
  25. 25. 2010 Revised WHO Guidelines<br />
  26. 26. Key Changes in 2010 Revised <br />WHO guidelines<br /><ul><li>Begin ART at CD4 cell count of 350 rather than 200
  27. 27. Start ARV prophylaxis earlier in pregnancy
  28. 28. Provide ARV prophylaxis during breastfeeding
  29. 29. Provide single drug Nevirapine daily to infants OR
  30. 30. Provide three drug ARV prophylaxis to the mother
  31. 31. National authorities should decide whether MCH services will recommend HIV-infected mothers to:
  32. 32. Breastfeed and receive ARV interventions OR
  33. 33. Avoid all breastfeeding</li></ul>(Taking into account socioeconomics, health services, and local infant mortality and under-nutrition)<br />
  34. 34. Infant HIV diagnosis<br /><ul><li>Early diagnosis of HIV infection in children born to HIV-infected women is critical
  35. 35. Allows early identification of children who will benefit from antiretroviral treatment, appropriate infant feeding choices, prophylaxis, and close medical follow-up
  36. 36. Decreases the psychological stress of uncertainty for the parents
  37. 37. HIV detection tests must be used in first 12-18 mos., then standard antibody tests are accurate
  38. 38. Early infant diagnosis using dried blood spots has made services available even in remote areas</li></li></ul><li>Infant Survival by HIV Infection Status -HIVNET 012 cohort<br />Proportion alive<br />Age (years)<br />
  39. 39. Goals of an HIV Care Program<br /><ul><li>Prevention of opportunistic infections
  40. 40. Early identification of complications and their appropriate management
  41. 41. Use of antiretroviral therapy to maintain and restore the immune system
  42. 42. Provision of support for HIV-infected persons, including psychosocial
  43. 43. Engage patients/families in HIV care and prevention through education, support and outreach
  44. 44. Establish strong links to community resources</li></li></ul><li>Basic Medical Care<br /><ul><li>Close Follow-Up and Health Monitoring</li></ul>- Prompt treatment of acute illnesses<br /><ul><li>Childhood Immunization
  45. 45. Vitamin A Supplementation
  46. 46. General Health Education (safe water, bednets)
  47. 47. Management of Diarrhea
  48. 48. Growth Monitoring & Nutrition Education</li></ul> - Early intervention/support<br />
  49. 49. WHO Indications for Initiation of ARV Therapy in Children < 2 Years<br /><ul><li>Initial WHO guidelines for ART in infants and children (2006) recommended starting therapy according to clinical/immunologic criteria
  50. 50. Studies in infants showed that there was a ~75% decrease in death when ART was started immediately rather than waiting
  51. 51. WHO revised recommendations in April 2008 such that ALL infants < 1 yr diagnosed with HIV infection should receive ART immediately
  52. 52. 2010 revised WHO guidelines increased this to all infants < 2 yrs of age</li></li></ul><li>Negotiating PMTCT Activities<br />?<br />
  53. 53. Negotiating PMTCT Activities (PMTCT = MCH)<br />
  54. 54. The Way Forward: Virtual Elimination of Pediatric HIV and AIDS worldwide<br />Challenges:<br /><ul><li>High initial implementation costs
  55. 55. Community sensitization/mobilization lacking
  56. 56. Integration of PMTCT within antenatal clinics can be difficult
  57. 57. Access to women who don’t deliver in health facilities
  58. 58. Very low numbers of male partners involved
  59. 59. Inadequate infant feeding education
  60. 60. Poor postnatal follow-up</li></ul>Successes:<br /><ul><li>Despite the challenges in scaling up PMTCT services, we know this can be done, and we have done it
  61. 61. We are making great progress worldwide, but we need to keep pushing forward to achieve universal access</li></li></ul><li>We can… <br />eliminate pediatric HIV and AIDS!<br />
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