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AIDS Healthcare Foundation
• Press Release
Open Letter to Margaret Chan/WHO to Save Mothers' LivesNovember 26, 2008 Dear Community Colleagues,
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).  At 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 GeneralNovember 26, 2008 Dr. Margaret Chan, Director General 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.
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. Sincerely, Michael Weinstein, President Homayoon Khanlou, MD, Chief of Medicine USA Robert R. Redfield, Jr., MD, Professor/Chief of Infectious Diseases Jane Aronson, MD, CEO/Founder Sophia Mengistu, MD, Country Director/Ethiopia Rodney L. Wright, MD, MS, Director of HIV Programs Martina C. Fuchs, MD, PhD, CEO Julio Montaner, MD David Camerini, PhD Ninad Desai, MD Justin Wane, MD Musa Dankyau Robert Salata, MD Margaret Feeney, MD Thomas Patterson, PhD Halima Dawood Alan Leviton, MD Rolando Viani, MD Gilbert Bakasa, Pastor Judith Feinberg, MD Veronique Folack Sijou, President & Founder Riitta Dlodlo, MD Gladys Tether-Yeboah Elizabeth Dax, Prof and Director Moniek Albertinevan der Kroef, Policy Advisor Glyn Townson, Chair Chinkholal Thangsing, M.D. Patricia Campos, M.D. Bernard Okongo, M.D. Ndili Buhlungu, M.D. Pat Bumgardner, Reverend Patricia Burns Betty Anne Thomas Jonathan Jacobs Paula J. Lum, MD, MPH Zelaelm Adugna Mina Nakawuka, MD Faieza Sahid Sharon Murphy Lyza Archipov Bhawani Shanker Catherine Chien, MD Uraipun Jongthavorn, NP Maria Fedorova, Ms Laveeza Bhatti Alvaro Lopez, M.D. USA Paul DenOuden, MD Ian Frank Deborah Holmes MD Shubha Kerkar, MD Victor Lewis, M.D. Hans Spiegel, MD Thai, Nguyen Dr. N. Dayanandarao Nokku MD 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, aidsfocus.ch/Switzerland 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
This article was provided by AIDS Healthcare Foundation.
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HIV/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.
