While there were no groundbreaking developments in basic science or the treatment and care of HIV+ women, the conference did break ground by providing attendees with a clear understanding of just how much this disease impacts women in the developing world. Moreover, it left attendees with a better sense of the difficult work that lies ahead and a renewed desire to undertake that work.
The Achilles Heel of preventing mother-to-child HIV transmission remains breast-feedinga necessity for many women around the world. Two major studies report a decrease in the protective effect of short-course anti-HIV therapy to reduce transmission as a result of breast-feeding. By 12 to 18 months after birth, transmission rates rose to 24% and then 30%, respectively, as babies became infected via breast-feeding. Thus, strategies to reduce mother-to-child transmission must address related social and economic issues, such as feeding children.
Several studies are now looking at different strategies for safer breast-feeding. Early results from one study suggest that mixed breast-feedingbreast milk supplemented with cereal, juice, water and so forthhas higher risk of transmission compared to exclusive breast-feeding. The HIV transmission rates at 15 months were 19.4% in formula-fed infants, 24.7% in infants exclusively breast-fed and 35% in mixed-fed infants. More study is needed to determine the reason for these surprising results.
Challenges to stem the unabated spread of HIV among women garnered considerably less attention than decreasing mother-to-child transmission. Many sessions described the social, cultural and economic factors that must be addressed to decrease transmission rates among women. However, few sessions were able to offer concrete and presently attainable responses to address the problems.
In the future, one potentially effective tool may be microbicides, which include gels and lubricants that hopefully destroy HIV on contact. The goal with microbicides is to provide people with something they can apply, like a vaginal or rectal suppository, that would help them prevent infection. This approach might be particularly useful for people who have a difficult time negotiating safer sex and/or people in resource poor countries where obstacles exist to condom availability or use. If safe and effective microbicides are developed, they may one day be a standard part of HIV prevention.
There were several sessions on microbicides, much of which highlighted some negative data linked to the use of nonoxynol-9, a spermicide found in many lubricants as well as lubricated condoms. Fortunately, a number of other microbicides are being studied now, including topical solutions of anti-HIV therapies. Several other products are also in late-stage development. Hopefully, products will soon be on the market to help reduce sexual transmission of HIV and other diseases.
Study results presented at the conference largely confirmed much of what we already know. These included studies reporting that women have different side effect patterns with certain drugs, that body composition changes may appear differently in women, that human papilloma virus (HPV, the virus associated with cervical and anal cancer), including anal HPV, is a persistent problem for positive women and that viral load and viral dynamics may differ between the sexes.
Comprehensive coverage of these and other topics specific to positive women, presented at the recent Durban conference, will be in the forthcoming issue of WISE Words, Project Inform's treatment newsletter for women. To receive WISE Words, call Project Inform's Hotline at 1-800-822-7422.