April 12, 2012
Recently released World Health Organization (WHO) guidelines aimed at ending perinatal HIV transmission advocate earlier and lifelong antiretroviral treatment for infected mothers-to-be. Doctors Without Borders (DWB) supports these guidelines.
DWB Medical Aid Coordinator Dr. Nathan Ford said perinatal HIV transmission remains hugely problematic in developing countries. "There are around 2 million HIV-positive children in developing countries, whereas in the United Kingdom, for example, there are just 70. So, we've almost got rid of this problem in the West."
Ford noted that previous recommendations called for placing HIV-positive expectant mothers on antiretrovirals only during pregnancy. Once they delivered, treatment would be discontinued unless the women fell ill, often measured by a CD4 count below 200, or became pregnant again.
Ford maintains that starting and keeping women on "antiretrovirals irrespective of their level of immunity" for life would simplify the process in rural areas, and eliminate the need "to keep restarting and stopping and restarting" treatment, which could lead to drug resistance or a lag time that would compromise the unborn child.
Although this change in course would cost more initially, Ford said, "Treating an HIV-positive child for life is incredibly expensive. So, avoiding those infections is going to be cost-saving in the long run."
The WHO guidelines effectively align treatment in developing and developed countries, and DWB notes the potential benefits for millions of people.
"Providing treatment earlier is not only good for an individual's health, but it's also good for preventing the spread of the virus from one person to another," said Ford. "And that's not just pregnant women. That's any HIV-positive adult."