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Press Release

Open Letter to Margaret Chan/WHO to Save Mothers' Lives

November 26, 2008

Dear Community Colleagues,

Open Letter to Margaret Chan/WHO to Save Mothers' LivesHIV/AIDS physicians and advocates around the world call on the Director General of the World Health Organization, Dr. Margaret Chan, to revise WHO guidelines to save the lives of women. We call on Dr. Chan and the WHO to show leadership in stopping harmful single-dose treatment for expectant mothers and infants.

Calling for an immediate revision of WHO's treatment guidelines to reflect current knowledge regarding the dangers of single-dose treatment is a broad coalition led by AIDS Healthcare Foundation (AHF). Supporters include Dr. Homayoon Khanlou, AHF's Chief of Medicine, USA; Dr. Julio Montaner; Dr. Robert R. Redfield Jr., Director of the HIV Program at the University of Maryland, School of Medicine; Dr. Jane Aronson, CEO/Founder of Worldwide Orphans Foundation; Dr. Sophia Mengistu, Country Director/Ethiopia, Worldwide Orphans Foundation; Dr. Rodney L. Wright, Director of HIV Programs, Albert Einstein College of Medicine; and, Dr. Martina C. Fuchs, Founder/CEO, Real Medicine Foundation. (Sign on if you would like to join this growing coalition).

Open Letter to Margaret Chan/WHO to Save Mothers' LivesAt issue with changing the standard of care are clinical efficacy and fairness. Numerous studies have shown that a short-course, single-dose regimen can raise the risk of viral resistance and jeopardize the effectiveness of future treatment for the mother as well as the child, if transmission prevention fails and treatment is needed. Just one example: a recent study comparing anti-HIV treatment regimens -- "DSMB Finds Ritonavir-boosted Lopinavir Superior to Nevirapine in HIV-positive Women Who Previously Took Single-dose Nevirapine" published on October 28, 2008 as a bulletin in the National Institute of Allergy and Infectious Diseases -- demonstrates the ineffectiveness of Nevirapine to treat HIV-infected women who previously took single-dose Nevirapine to avoid transmitting HIV to their newborns.

The largest study of mother-to-child transmission rates to date, published in 2008 in the journal AIDS, found that if appropriate full-course treatment is administered, 99% of babies were born uninfected with HIV. We call on Dr. Chan to commit today to saving the lives of mothers as well as their babies.

It is wrong to continue a practice that endangers the lives of mothers and infants while low-cost full-course treatment is available. While the current WHO guidelines acknowledge the risk of viral resistance, single-dose therapy remains a recommended method. Since most developing countries rely on the guidelines to help shape health policy, WHO must lead the way toward widespread implementation of full-course therapy for all expectant mothers and infants. The health outcomes of thousands of women would be vastly improved and the lives of thousands of children could be saved.

Open Letter to Dr. Margaret Chan, World Health Organization Director General

November 26, 2008

Dr. Margaret Chan, Director General
World Health Organization
Avenue Appia 20
CH - 1211 Geneva 27

Re: WHO Guidelines for the Use of HAART in HIV Infected Pregnant and Breastfeeding Women

Dear Director Chan,

We the undersigned HIV/AIDS medical care providers and advocates are concerned about the use and recommendation of short-course therapy (such as single-dose Nevirapine and/or Zidovudine) for expecting and breastfeeding mothers considered ineligible for full-course Highly Active Antiretroviral Therapy (HAART) by WHO's current guidelines. Short-course treatment has been proven to be less effective at preventing HIV transmission and less safe for both mother and child than a full HAART regimen. Therefore, we call for World Health Organization (WHO) treatment guidelines to be changed to recommend full-course antiretroviral treatment for all expecting and breastfeeding mothers worldwide.

Open Letter to Margaret Chan/WHO to Save Mothers' LivesIt is universally acknowledged that the reduction -- and eventual elimination -- of HIV among children represents not only a moral obligation but also an important front in preventing new HIV infections. Currently, over 2 million children are infected with HIV and there are several hundred thousand children born HIV positive each year (an estimated 330,000 to 410,000 in 2007). Over 90% of these infections are a result of transmission from HIV positive mothers to their infants [2008 AIDS epidemic update. Geneva, UNAIDS/WHO, 2008]. While these troubling numbers actually represent some progress compared to previous years, it is clear that more effective and sustainable interventions are needed to meet our commitment to reduce HIV among children and deaths among mothers.

Despite this, WHO guidelines on the prevention of mother to child transmission (PMTCT) still recommend short-course therapy even though it is clinically less effective at preventing MTC transmission and more harmful than full-course antiretroviral treatment. In contrast, the use of full-course ARV therapy essentially eliminates MTC transmission, lowering the overall risk to as little as 1.2%. The largest study of MTCT rates to date found that when appropriate full-course treatment is administered, 99% of babies were born uninfected with HIV. Moreover, these findings are consistent with several other studies that found that the primary effect of HAART, a reduction in the amount of HIV virus in the body, also essentially eliminates the risk of acquiring HIV via sexual transmission.

However, changes to the clinical practices of countries using short-course therapy cannot take place without the WHO's leadership. Most developing countries rely on WHO guidance before they change or implement any clinical policy; therefore it is imperative for the WHO to revise its treatment guidelines on this matter to help facilitate the transition from short-course therapy to full-course HAART.

Widespread implementation of this standard will dramatically reduce the number of children born with HIV, reduce the number of women at risk for developing resistance to standard first-line treatments and will have a tremendous economic impact in lower income countries as the number of people requiring higher-priced second-line treatments will also be reduced. Implemented worldwide, the health outcomes of thousands of women would be vastly improved and the lives of thousands of children could be saved.

We look forward to the WHO's leadership and action on this matter.


Michael Weinstein, President
AIDS Healthcare Foundation

Homayoon Khanlou, MD, Chief of Medicine USA
AIDS Healthcare Foundation

Robert R. Redfield, Jr., MD, Professor/Chief of Infectious Diseases
University of Maryland, School of Medicine

Jane Aronson, MD, CEO/Founder
Worldwide Orphans Foundation

Sophia Mengistu, MD, Country Director/Ethiopia
Worldwide Orphans Foundation

Rodney L. Wright, MD, MS, Director of HIV Programs
Albert Einstein College of Medicine

Martina C. Fuchs, MD, PhD, CEO
Real Medicine Foundation

Julio Montaner, MD

David Camerini, PhD
University of California/USA

Ninad Desai, MD
Kings County Hospital Center/USA

Justin Wane, MD
Association of African Universities/Ghana

Musa Dankyau
Director of Medical Services/ECWA Medical Department/Nigeria

Robert Salata, MD
Case Western Reserve University/USA

Margaret Feeney, MD
Harvard Medical School/USA

Thomas Patterson, PhD
University of California San Diego/USA

Halima Dawood
Principal Specialist: Infectious Diseases, Greys Hospital/South Africa

Alan Leviton, MD
Montefiore Medical Center/USA

Rolando Viani, MD
University of California San Diego Medical Center /USA

Gilbert Bakasa, Pastor
Nazarene Compassionate Ministries/Zambia

Judith Feinberg, MD
University of Cincinnati/USA

Veronique Folack Sijou, President & Founder
Women's Promotion and Assistance Assoc./CAMEROON

Riitta Dlodlo, MD

Gladys Tether-Yeboah
World Vision International/Ghana

Elizabeth Dax, Prof and Director
National Serology Reference Laboratory, & Director of WHO CC on Diagnostics/Australia

Moniek Albertinevan der Kroef, Policy Advisor
STOP AIDS NOW!/Amsterdam

Glyn Townson, Chair
BC Persons With AIDS Society/Canada

Chinkholal Thangsing, M.D.
Asia Pacific Bureau Chief, AHF India Cares /India

Patricia Campos, M.D.
Latin America Bureau Chief, AHF Latin America

Bernard Okongo, M.D.
East-West Africa Bureau Chief, AHF Uganda Cares /Uganda

Ndili Buhlungu, M.D.
Southern Africa Bureau Chief, AHF Southern Africa

Pat Bumgardner, Reverend
Global Justice Ministry of Metropolitan Community Churches/USA

Patricia Burns
Senior Programs Manager, Harvard School of Public Health/USA

Betty Anne Thomas
Executive Director, Hamiltom AIDS Network/Canada

Jonathan Jacobs
Professor of Clinical Medicine, Weill Cornell Medical College/USA

Paula J. Lum, MD, MPH
University of California, San Francisco/USA

Zelaelm Adugna
Save the Children/Ethiopia

Mina Nakawuka, MD
AIDS Healthcare Foundation/Uganda

Faieza Sahid
University of Kwa-Zulu Natal/South Africa

Sharon Murphy
The McGregor Clinic/USA

Lyza Archipov
McGregor Clinic, Inc./USA

Bhawani Shanker
Kusum Secretary & Executive Director, Gram Bharati Samiti (GBS)/India

Catherine Chien, MD
AIDS Healthcare Foundation/USA

Uraipun Jongthavorn, NP
AIDS Healthcare Foundation/USA

Maria Fedorova, Ms
Abbott Laboratories/Russia

Laveeza Bhatti
Clinical Instructor of Medicine, AIDS Healthcare/ UCLA/USA

Alvaro Lopez, M.D. USA

Paul DenOuden, MD
AIDS Healthcare Foundation/USA

Ian Frank
Professor of Medicine University of Pennsylvania/USA

Deborah Holmes MD
AIDS Healthcare Foundation/USA

Shubha Kerkar, MD
AIDS Healthcare Foundation/USA

Victor Lewis, M.D.

Hans Spiegel, MD
Montefiore Children's Hospital/USA

Thai, Nguyen
Medical Doctor, AIDS Healthcare Foundation/USA

Dr. N. Dayanandarao Nokku MD
Holy Family vo Routhulapudi/India

Abel Akara Ticha , Summit Magazine/Cameroon

Aisha Nazli, McMaster University/Canada

Alan Todd /United States

Alex Govender, Volkswagen South Africa/South Africa

Alicia Peterson, Positive Healthcare/USA

Angela Janse vanRensburg, AHF/USA

Angela Giovanniello, Pharm D, Montefiore/USA

Angelica Skouras

Anita Gillespie/United States

Ann Smith, HIV Corporate Strategist, CAFOD/England

Anthony Bolden, Individual/USA

Arcelia Paz Promise/Mexico

Augusto Lugo/USA

Barbara Weiser, Wadsworth Center/US

Benjamin Nwammadu, Administration Manager Center for the Right to Health, ImoState Action Committee on AIDS/Nigeria

Brenda Done, St Joseph's Health Care/Canada

Bright Drah, University of Toronto/Canada

Carl Goff /USA

Carol Griffin

Cesar Carrasco Ayala, Coesida/Mexico

Chandarith Cheang, UNV/Malawi

Chinyere Uzomba, Spectrum Broadcasting LTD/Nigera

Chris Troupe, Provider Relations Representative, AIDS Healthcare Foundation/

Christina Slack, Out of the Closet/USA

Christine Pasmore/United States

Claudia Grinzi/Australia

Clement Banwiwo, NAP/Ghana

Compaor Zonabo, Vie Positive/Burkina Faso

Daniel Alberto Ruvalcaba Herrera, Enlaces de la Diversidad A.C./Mexico

Danny Ray/USA

Dao Lieu, AIDS Healthcare Foundation/USA

David Zakus, Centre for International Health, Dalla Lana School of Public Health, University of Toronto/Canada

Dean Stephens, Fraser Communications/USA

Deborah Lobban, Reborn Classics/Canada

Deon Davis, Rrip-It Condoms/USA

Devika Jayasinghe, AIDS Healthcare Foundation/USA

Dhayan Dirgantara, Spiritia Foundation/Indonesia

Diana Guerrero, AHF/USA

Dinesh Singh, Open Door/South Africa

Dipen Prajapati, Micro Are Trust/India

Donald Bliss/United States

Dorit Thies/USA

Dr Thomas Ellison, Project Help/Usa

Nandlal Jotwani, Ph.D., President, Global Harmony, Non-Profit Ngo/India

Dr. Patricia E Gonzalez Moreno, MD, Programa Binacional Materno Infantil/Mexico

Eartha Dumond, International Children Aide Reaching Everyone/Broward

Ejay de Wit/The Netherlands

Elisabeth Crafer, Positively Women/England

Emery Chang, UCLA/USA

Ernestine Bailey, AHF/USA

Ethel Kapyepye, World Vision International/Malawi

Etsuko Kita, JRC Kyushu Int'l College of Nursing/Japan

Evah Budala, Trinity College Department of Global Helath/Ireland

Federico Lopez, Case Manager, SRO Housing Corporation/USA

Fil - Jr. Tabayoyong, Baptist Medical Missions International/Cambodia

Flora Raines-Pinkerton, Desoto County Dept of Health/USA

Francisco Xavier De Melo, Love Life Society/India

Georgina Gutierrez, Coordinadora Nacional, Movimiento Mexicano de Ciudadana Positiva/Mexico

Glynis Alonzo-Beaton, Young Women's Christian Association/Guyana

Guerline Toussaint/United States

Harold Burger, Program Director, Viral Disease Research Physician, Wadsworth Center/USA

Harriet Kivumbi, Private/Uganda

Harry Luecke, AIDS Healthcare Foundation/USA

Helena Zweifel,

Holly Shea, Medical Assistant/Health & Safety Instructor /USA

Ian Woolley/Australia

Irene K Adams, Clinica AMMOR/Brazil

Isabel Pinto-Coelho Sena, AIDS Healthcare Foundation/Netherlands

Jacqueline Green, AHF/USA

Jacqueline Quintanilla, AIDS Healthcare Foundation/UNITED STATES

Jacques Mokhbat, Lebanese AIDS Society/Lebanon

Jane Lennon/UK

Janet Feldman, Founder/Director, KAIPPG International, ActALIVE/USA

Janet Pierce/USA

Jason Farmer

Jazmyn Hallman/Canada

Jeanne Hershey-Weber, Nurse Practitioner, A.H.F./U.S.A.

Jennifer Gauthier, AIDS Healthcare Foundation/United States

Jessica Godinez/USA

Joanna Hernandez, AIDS Healthcare Foundation/USA

JoAnna Rhoden-Plaza

John Hawes, The AIDS Reader/USA

Josephine Irene Uwamariya

Juline Lewis, Board of Director, The Jamaican Network of Seropositives/Jamaica West Indies

Kabore Emmanuel, Sos Sida/Burkina Faso

Karen Haughey, RN, Positive Healthcare/AIDS Healthcare Foundation/USA

Karl Shaw/USA

Kashif Khan, Executive Director, Feel… living for others/Pakistan

Katarina Lindahl, Secretary General of the Swedish Association for Sexuality Education, RFSU/Sweden

Katherine Finley, AIDS Healthcare Foundation

Kathleen Wolff

Kavitha Anisetty/USA

Keith Sadler, Atlantic County Dept. of Family & Community Development/United States

Kelly Blanpied, AIDS Healthcare Foundation/USA

Kim Neuhauser/USA

Koteswa Ra Rao Seelam, Health & Education For Social Action/India

Kumar Gaurav, Assistant V.P. & Head of Consulting Practice at Zensar , Govt of Gujarat/India

Kurt Frieder, Director, Fundacion Huesped/Argentina

Lakshmi Bonthu, one million tests, Adarsha Education Society/India

Lark Lands, H.O.P.E./USA

Laura Ballinger, AHF/Positive Healthcare/United States

Lauren Sporillo

Liani Parte, ZAA/India

Lisa Hamilton, AIDS Healthcare Foundation/United States

Liza Santiago

Logan Berkana

Lola Delgadillo, Galegi/Mexico

Louise Hogarth, Dream Out Loud/USA

Lydia Gresham, AIDS Healthcare Foundation

Manizha Haitova, Center on Mental Health and HIV/AIDS/Tajikistan

Manuel Garcia, AIDS Healthcare Foundation

Mara Kumbweza Banda, Paradiso House Home Based Care/Malawi

Marco Rodriguez, Leon Gay/Mexico

Margie McGough, AHF/PHC/USA

Maria Agustina Rodriguez Hernandez, MEXFAM/Mexico

Marie Levek, AIDS Healthcare Foundation/USA

Mary Glenn/United States

Maryann Oscar, Positive Healthcare/AHF/United States

Melissa Bailey, AIDS Healthcare Foundation/USA

Melissa Castaneda, AIDS Healthcare Foundation/USA

Michael Kaltenbach, AHF/USA

Michael Zimmerman, AIDS Healthcare Foundation/

Michael K. Hart/Canada

Milka Cherotich, Chairlady Treasurer, Jumuiya Women Group/Kenya

Monica Rutherford, AHF/Positive Healthcare/USA

Moore Jeff

Nahgwa Rebecca Ogbimi, Mrs., Health Reform Foundation of Nigeria/Nigeria

Natalia Marlowe, Celera

Nguyen Dinh Anh, General Office of Population and Family Planning, Ministry of Health/Vietnam

Nomalizo Matsheketwa, AIDS Healthcare Foundation/South Africa

Oladimeji Arewa, Niger Delta University Teaching Hospital Bayelsa State Nigeria/Nigeria

Padam Chand , NCASC/Nepal

Panjasaram Naidoo, IAS/South Africa

Pansy East, Program Manager AHF Healthcare Centers, AIDS Healthcare Foundation/USA

Parveen Kaur, AHF/USA

Pascale Robitaille, Sexologist, Stella/Canada

pavan kumar konduri, THREADS/India

Peninah Mwangi, Bar Hostess Programme/Kenya

Peter Ziba, Pastor, CHILA TB, HIV/AIDS Advocates/Zambia

Prakash Jeena, Department of Paediatrics/South Africa

Priyadarshini Indira, Rass/India

Rajeswara rao Kakarlamudi , GAWS/India

Ramesh Tiwari, Secretary, Manav Kalyan Pratisthan/India

Randolph Shannon, AIDS Committee of Ottawa/Canada

Ransford Bekoe , Christ Presby HIV Club/Ghana

Ravi Kumar, 1 Million Tests, Bandi Srinivasarao Memorial Social Service Society/India

Renata Martinez, CEPAVIH/Mexico

Renee Dozier/USA

Richard Meech, Hawkes Bay DHB/New Zealand

Rick Quezada, AIDS Healthcare Foundation/USA

Robert Catalla, Ahf Jacksonville/Usa

Robindro Rajkumar, Production Assistant, Doordarshan/India

Rodman Davis, Ceo, Rrip-It Condoms/USA

Roger Cervantes de la rocha, senor, redcor/costa rica

Rosie Mngqibisa, ACTG/South Africa

Roy Dhlamini/Zimbabwe

S.M Nazer Hossain, Integrated Social Development Effort (ISDE) Bangladesh/Bangladesh

S.M Rezaul Islam, Bandhu Social Welfare Society/Bangladesh

Saka Mohammed Jimoh , Health Reform Foundation of Nigeria (HERFON)/Nigeria

Salvador Meza Ortiz , Grupo Vihda Puebla/Mexico

Sandeep Saluja, AIIMS/India

Sandra Walker

Sandy Tzogas/Canada

Sandy Walker

Sara Edna Carriles Vargas, CAPASITS Tampico/Mexico

Sarath Chhim, AHF-Cambodia Cares/Cambodia

Scott McKenzie, Registered Nurse/USA

Shailesh Pednekar/India

Sherri Montiy , AHF/Positive Healthcare/USA

Shilpa Sayana, MD, MPH, AHF

Shivaswamy Rajendra Prasad, Swami Vivekananda Youth Movement/India

Sibongile Zigana/South Africa

Simone Le Moal

Siva Shankara Rao Sudani, Mr., Health Organisation For Poor Earners (Hope)/India

Sivanna.K.John John, Kadiyam, New Living Hope Rural Development Society/India

Sonia Rodney/United States

Sophie Billot

Sostena Romano/USA

Srihari Yamanoor, Self/USA

Stephen Talugende, Captain, Uganda Peoples Defense Forces/Uganda

Susana Sandra Oliver, Professor, Sexuality Gender Deaf And Disability/Mexico

Tamara Finkler

Tay Aston

Terry Anderson/USA

Thaidra Gaufin

Thando Mwelase, Medical Officer In A Research Unit/South Africa

Thol Men/Cambodia

Tinne Laursen, Infectious Diseas dep. Skejby/Denmark

Titchui Chan, MS

Todd Cross

Trudie Harrison, Mosamaria AIDS Ministry/South Africa

Ursula Brown, Volunteer, The Aids Network, Hamilton, Ontario, Canada/Canada

Vin Samnang, AIDS Healthcare Foundation, AHF Thailandcares, Center of Hope/Thailand

Wesley Chirchir, Kenya Community Sports Foundation/Kenya

William Holzemer, RN, PhD, FAAN, University of California, San Francisco/USA

William Cintron/USA

Yang Yang/USA

Zonabo Compaor, Consillre, Vie Positive/Burkina Faso

Zora Mahdavi /United States

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This article was provided by AIDS Healthcare Foundation.
See Also
Pregnancy and HIV/AIDS in the Developing World