HIV in Children: Preventing Mother-to-Child Transmission

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Dr. Laura Guay, the Foundation’s Vice President of Research, also conducted a journalist training today sponsored by the National Press Foundation, teaching reporters about some of the most misunderstood issues concerning HIV and children

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HIV in Children: Preventing Mother-to-Child Transmission

  1. 1. HIV in Children:<br />Preventing Mother-to-Child Transmission<br />Dr. Laura Guay<br />Vice President for Research<br />Elizabeth Glaser Pediatric AIDS Foundation<br />J2J Global Media Training on HIV/AIDS<br />July 14, 2010<br />Vienna, Austria<br />
  2. 2. Elizabeth Glaser<br />
  3. 3. Ariel and Jake Glaser<br />
  4. 4. The Elizabeth Glaser Pediatric AIDS Foundation<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 infections among children, 1990–2007<br />
  15. 15. Provision of Antiretroviral Drugs<br />55% of pregnant womennot receiving PMTCT drugs<br />68% of HIV-exposed infantsnot receiving PMTCT drugs<br />WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009<br />
  16. 16. Benefits of global expansion of PMTCT programs<br /><ul><li>Provides opportunity for primary prevention for large number of identified HIV-uninfected women
  17. 17. Provides opportunity for prevention of HIV infection in children
  18. 18. Provides opportunity as an entry point into HIV Care for large number of HIV-infected women and their infected infants
  19. 19. 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 />
  20. 20. Timing of HIV transmission to the infant<br />During pregnancyAround labour/deliveryDuring Breastfeeding<br />
  21. 21. 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 />
  22. 22. 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 />
  23. 23. Breast Feeding vs Bottle Feeding<br />
  24. 24. 2009 Revised WHO guidelines<br />
  25. 25. Key Changes in 2009 Revised <br />WHO guidelines<br /><ul><li>Begin ART at CD4 cell count of 350 rather than 200
  26. 26. Start ARV prophylaxis earlier in pregnancy
  27. 27. Provide ARV prophylaxis during breastfeeding
  28. 28. Provide single drug Nevirapine daily to infants OR
  29. 29. Provide three drug ARV prophylaxis to the mother
  30. 30. National authorities should decide whether MCH services will recommend HIV-infected mothers to:
  31. 31. Breastfeed and receive ARV interventions OR
  32. 32. Avoid all breastfeeding</li></ul>(Taking into account socioeconomics, health services, and local infant mortality and under-nutrition)<br />
  33. 33. Infant HIV diagnosis<br /><ul><li>Early diagnosis of HIV infection in children born to HIV-infected women is critical
  34. 34. Allows early identification of children who will benefit from antiretroviral treatment, appropriate infant feeding choices, prophylaxis, and close medical follow-up
  35. 35. Decreases the psychological stress of uncertainty for the parents
  36. 36. HIV detection tests must be used in first 12-18 mos., then standard antibody tests are accurate
  37. 37. 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 />
  38. 38. Goals of an HIV Care Program<br /><ul><li>Prevention of opportunistic infections
  39. 39. Early identification of complications and their appropriate management
  40. 40. Use of antiretroviral therapy to maintain and restore the immune system
  41. 41. Provision of support for HIV-infected persons, including psychosocial
  42. 42. Engage patients/families in HIV care and prevention through education, support and outreach
  43. 43. 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
  44. 44. Vitamin A Supplementation
  45. 45. General Health Education (safe water, bednets)
  46. 46. Management of Diarrhea
  47. 47. Growth Monitoring & Nutrition Education</li></ul> - Early intervention/support<br />
  48. 48. 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
  49. 49. Studies in infants showed that there was a ~75% decrease in death when ART was started immediately rather than waiting
  50. 50. WHO revised recommendations in April 2008 such that ALL infants < 1 yr diagnosed with HIV infection should receive ART immediately
  51. 51. Recent revised WHO guidelines increased this to all infants < 2 yrs of age</li></li></ul><li>Negotiating the PMTCT Activities<br />?<br />
  52. 52. Negotiating the PMTCT Activities (PMTCT = MCH)<br />
  53. 53. The Way Forward<br />Challenges:<br /><ul><li>High initial implementation costs
  54. 54. Community sensitization/mobilization lacking
  55. 55. Integration of PMTCT within antenatal clinic can be difficult
  56. 56. Access to women who don’t deliver in health facility
  57. 57. Very low numbers of partners involved
  58. 58. Inadequate infant feeding education
  59. 59. Poor postnatal follow-up</li></ul>Successes:<br /><ul><li>Despite the challenges, we know this can be done, we have done it
  60. 60. We are making great progress worldwide, but we all need to keep pushing forward</li></li></ul><li>Tunaweza: Together, we can… <br />Eliminate Pediatric HIV<br />

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