Developing Options for Perinatal HIV Prevention in the Developing World
Researchers Worldwide Collaborate to Develop Practical Therapies
Worldwide, it is estimated that more than 1 million children have been infected with HIV through mother-to-infant (perinatal) transmission. The World Health Organization (WHO) projects that during this decade alone, 5-10 million children will become infected with HIV through perinatal transmission, the vast majority in the developing world.
In 1994, clinical trials in the United States demonstrated that it is possible to reduce perinatal transmission through the use of an antiretroviral drug. Specifically, clinical trials conducted by the National Institutes of Health (NIH) showed that HIV-infected women could reduce the risk of transmitting the virus to their babies by as much as two-thirds through administration of zidovudine (ZDV or AZT) during pregnancy, labor, and delivery, and by giving their babies AZT for the first 6 weeks after birth. Researchers and public health practitioners from around the world convened in Geneva in June 1994 to define the public health implications of the results for the industrialized and the developing world.
The international panel recommended that the 076 regimen be used in the industrialized world where it is feasible, but immediately called for the exploration of alternative regimens that could be used in the developing or newly developed world, stating that cost and logistical issues would preclude the widespread application of the 076 regimen. The panel called for international coordination of research efforts to develop simpler, less costly drug regimens. Barriers which currently preclude the implementation of 076 in the developing world, and which must be overcome in order to develop realistic options for these nations include:
Because there are currently no interventions available to prevent perinatal HIV transmission to infants in most developing countries, the panel specified that placebo-controlled trials should be designed to provide rapid and scientifically valid assessment of alternative drug regimens.
The placebo-controlled design will allow researchers to compare new regimens to the current standard of care in the developing world (which in most developing nations is no intervention) and to identify any potential side effects associated with the new regimens. The panel also stressed that any intervention tested in the developing world must be affordable, feasible, and sustainable in that setting. With this guidance, CDC, NIH, WHO, and UNAIDS are working with researchers worldwide to determine if there are simpler preventive therapies or practices which can reduce perinatal transmission. Several placebo-controlled studies are ongoing and summarized below.
Researchers are optimistic that these studies will lead to further understanding of the mechanisms of mother-to-infant HIV transmission and the mechanisms of prevention. Ultimately, the goal is to develop the most effective, simple, and safe therapy option -- one that is affordable and feasible for the area where over 90% of new HIV infections occur -- the developing world.
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