May 12, 2011

Preventing Perinatal HIV Transmission Newsletter: Field Update Banner Logo

New Resources:

New Listserv Provides Forum for HIV Clinicians

A consortium of organizations specializing in HIV and infectious diseases has developed a listserv for clinicians.

The ReproIDHIV listserv is a forum for discussing clinical cases, finding patient referrals, sharing protocols, providing information on upcoming events and networking with colleagues in the HIV and infectious diseases communities.

The listserv is sponsored by the UCSF National HIV/AIDS Clinicians’ Consultation Center, Infectious Disease Society of Obstetricians and Gynecologists and UCSF Fellowship in Reproductive Infectious Disease.

To be added to the listserv, contact Shannon Weber at sweber@nccc.ucsf.edu.

CDC Issues New Guidance for HIV Testing in Community Health Centers

The CDC has developed a new resource for HIV testing in community health centers. The guide provides information on testing protocols and post-test counseling.

To access the guide, visit www.cdc.gov/hiv/topics/testing/resources/guidelines/pdf/routineHIVtesting.pdf.

Kaiser Produces Fact Sheet on HIV and Women in the U.S.

Women in the U.S. contract HIV primarily through heterosexual contact. The majority of those women are African-Americans.

These are some of the facts presented in the recent update on HIV and women produced by The Henry J. Kaiser Family Foundation.

To view the fact sheet, visit http://www.kff.org/hivaids/upload/6092-09.pdf.

HIV/AIDS Prevention Bilingual Glossary Widget Available

The CDC has produced an English/Spanish widget for its HIV/AIDS Prevention Bilingual Glossary. The glossary provides linguistic support to individuals and organizations working with Spanish-speaking populations in the United States.

For more information and to access the widget, go to HIV/AIDS Prevention Bilingual Glossary Widget - The Office of Minority Health.

NEWS AND RESEARCH UPDATES:

Trial Halted for Pill to Stop HIV in Women

A trial among women taking antiretrovirals daily to prevent sexually acquired HIV infection has been stopped early after a review suggested its data would be inconclusive. The results are contrast with data from a large, multi-country study presented last year that showed the approach - called pre-exposure prophylaxis (PrEP) - is protective against HIV for men who have sex with men.

The halted FEM-PrEP trial involved 1,951 women from South Africa, Kenya and Tanzania randomized to take either Truvada or placebo daily. Fifty-six acquired HIV: exactly half in the Truvada arm and half in the placebo group.

Reasons for FEM-PrEP's inconclusive results remain speculative, but lapses in adherence could be to blame. Blood samples taken to measure adherence still must be analyzed, said researchers.

For more information, visit http://www.cdc.gov/hiv/prep/femprep.htm.

Demand for Safe Conception Methods Exists for HIV-Discordant Couples

Approximately half of HIV-discordant heterosexual couples in the United States want children, according to a recent study, indicating demand for pre-exposure prophylaxis to prevent mother-to-child transmission.

This is according to a recent article in the American Journal of Obstetrics and Gynecology authored by perinatal HIV experts from CDC. The authors state that couples should receive services to ensure they enter pregnancy in optimal health and receive education about all conception methods that reduce the risk of HIV transmission.

To view an abstract of the article, visit Achieving safe conception in HIV-discordant couple... [Am J Obstet Gynecol. 2011] - PubMed result.

Data Show One-Third of HIV-Infected Women Not Tested Before Pregnancy

CDC’s recent release of its Enhanced Perinatal HIV Surveillance data for 2005-2008 show that 30 to 35 percent of HIV-infected women are not tested for the virus until after they become pregnant.

These data are reported by 15 jurisdictions—health departments in nine states, five cities and Puerto Rico. In these regions alone, more than 8,000 HIV-infected women gave birth during the three-year period.

To access the full report, visit Enhanced Perinatal Surveillance—15 Areas, 2005–2008.

Study Indicated Need for Specialized Reproductive Care for HIV-Infected Women

A survey of HIV-infected women in the U.K., indicates that three-quarters of them want more children, and that almost half reported their HIV diagnoses did not affect their fertility intentions. These findings, in the April edition of AIDS Care, highlight the need for specialized family planning and reproductive health services targeting the population.

Some 450 women were surveyed in the U.K., where the number of pregnancies in HIV-infected women has increased dramatically in the past decade.

To view an abstract, visit Fertility intentions of HIV-infected women in the ... [AIDS Care. 2011] - PubMed result.

CDC Says Fewer Youth Report Having Sex

The largest and most in-depth report on U.S. sexual behavior, sexual attraction and sexual identity shows a rising number of young people are electing to remain abstinent. In 2006-2008, 29 percent of females and 27 percent of males ages 15-24 reported not having any sexual contact, compared with 22 percent in 2002, CDC said.

National Center for Health Statistics researcher Anjani Chandra, PhD, and colleagues used data based on computer-assisted interviews with 13,495 males and females ages 15-44. That 2006-2008 National Survey of Family Growth (NSFG) data was compared with results from the 2002 NSFG and other national surveys. The team found few overall changes in the nation’s sexual patterns compared to the 2002 survey. But for the first time, they examined certain, specific behaviors that young people may not always report as sex because it is not vaginal intercourse.

Among teenagers ages 15-19, 7 percent of females and 9 percent of males reported oral sex with an opposite-sex partner but no vaginal intercourse. Of sexually active people ages 15-24, almost 63 percent of females and 64 percent of males had oral sex, versus almost 69 percent in 2002.

The report, “Sexual Behavior, Sexual Attraction, and Sexual Identity in the United States: Data from the 2006-2008 National Survey of Family Growth,” was published in National Health Statistics Reports (2011:36). It can be found by visiting http://www.cdc.gov/nchs/data/nhsr/nhsr036.pdf.

Female Condoms Are Gaining Ground

First approved by the Food and Drug Administration (FDA) in 1993, the female condom was slow to gain acceptance. Now, however, the improved version, dubbed FC2, appears to be making headway, according to a manufacturer.

The number of FC2s distributed in the United States last year tripled, said Mary Anne Leeper, founder of its manufacturer, the Female Health Company. The product now is sold in more than 100 nations, and it even has fans on Facebook.

Whereas the original female condom was made of polyurethane, the improved version, approved by FDA in March 2009, is seamless and made of more comfortable synthetic latex. For more information, go to http://www.femalehealth.com/.

Five-Drug HIV Therapy No Better than Standard

Increasing the number of antiretrovirals administered to treat acute and early HIV infection is not effective, according to a study presented at the recent Conference on Retroviruses and Opportunistic Infections.

Forty-eight weeks into the 96-week study, patients receiving five drugs had equivalent amounts of HIV RNA in their blood compared to those receiving the standard three-drug therapy, and there also was no difference in a range of other immune system measurements, said Martin Markowitz, MD, of New York’s Aaron Diamond AIDS Research Center.

Markowitz and colleagues enrolled 40 early-stage HIV patients and randomly assigned them, in a one-to-two fashion, to receive either three or five medications.

Thirty-four patients remained in the study. Among results at 48 weeks:

  • While the five-drug patients achieved undetectable HIV RNA levels more rapidly than the three-drug patients, by 24 weeks there was no significant difference in the proportion with undetectable virus.
  • In both study arms, patients had strong recovery of CD4+ cells of about 300 each; there was no significant difference between the groups.
  • No differences were found in levels of proviral DNA or cell-associated HIV RNA, or their rates of decay over time.
  • No differences were found in levels of naïve and total CD4 cells or immune system activation markers.
  • All three patients who had virological failure were in the five-drug group.
  • No different responses were found between those who were acutely infected, about one-quarter of patients, and those in the later-early phase.

For more information, go to 5 Drugs No Better than 3 for Treatment of Primary HIV Infection.

FDA Warns Against Abbott HIV Drug in Premature Babies

The FDA advised against using Kaletra (lopinavir/ritonavir) oral solution in premature babies, which can cause severe or possibly fatal health problems, and in all babies younger than 14 days. There is no safe, established dose for babies younger than two weeks, whether premature or full-term, FDA said.

The Kaletra oral solution contains alcohol and propylene glycol, and the inability of premature babies to eliminate propylene glycol can lead to adverse events, including "serious heart, kidney or breathing problems," said the notice to health professionals. FDA has received reports of serious problems in premature babies receiving Kaletra.

"Because the consequences of using Kaletra oral solution in babies immediately after birth can be severe or possibly fatal, the label is being revised to include the new warning," stated the notice. "The use of Kaletra oral solution should be avoided in premature babies until 14 days after their due date, or in full-term babies younger than 14 days of age unless a health care professional believes that the benefit of using Kaletra oral solution to treat HIV infection immediately after birth outweighs the risks. In such cases, FDA strongly recommends monitoring for increases in serum osmolality, serum creatinine, and other signs of toxicity."

For additional information, visit http://www.fda.gov/Drugs/DrugSafety/ucm246002.htm.

High Levels of HIV in Genital Secretions Predict Infectiousness

HIV-1 RNA concentrations in semen and vaginal secretions can be used as a marker for HIV transmission risk, suggests a new two-year study of serodiscordant heterosexual couples in Africa. The relation was independent of plasma HIV-1 concentrations, noted Jared Baeten, MD of the University of Washington.

Researchers for years have known of the link between HIV concentration in the blood and the risk of transmission, Baeten said. However, no studies have been large enough to conclusively establish the same for HIV in genital secretions, beyond a working hypothesis, he said.

In the prospective study, Baeten and colleagues followed 2,521 serodiscordant heterosexual couples from seven African countries, assessing genital HIV-1 RNA quantity and transmission risk for up to two years. Couples received HIV prevention counseling, and viral sequence analysis was used to confirm subsequent HIV transmissions.

The researchers tested endocervical samples from 1,805 women, including 46 women who transmitted HIV to their partner, and semen samples from 716 men, including 32 who infected their partner.

"There was a correlation between genital and plasma HIV-1 RNA concentrations," wrote the study authors. Even so, genital HIV-1 RNA independently predicted transmission risk after adjusting for plasma HIV quantity, the study found.

The study, "Genital HIV-1 RNA Predicts Risk of Heterosexual HIV-1 Transmission," was published in Science Translational Medicine (2011;3(77):77ra29).

CDC Finds Disparities in Diagnoses of HIV Infection

Since early in the HIV epidemic, blacks/African Americans have been disproportionately affected, according to the CDC. Drawing on data from the National HIV Surveillance System, they estimated numbers, percentages and rates of HIV diagnoses in blacks/African Americans during 2005-08 and described the results of those analyses.

During 2005-08, blacks/African Americans accounted for 50.3 percent of HIV diagnoses in 37 states with mature HIV surveillance systems, despite representing just 13.6 percent of the population in these states. By comparison, whites accounted for 67.9 percent of the population and 29.4 percent of diagnoses, while Hispanics/Latinos accounted for 13.4 percent of the population and 17.8 percent of diagnoses.

Among males, black/African Americans represented the largest proportion (44.8 percent) of HIV diagnoses during 2005-08. Among females, black/African Americans accounted for most (65.9 percent) diagnoses, including a majority for the South (70.9 percent), Midwest (60.9 percent) and Northeast (60.0 percent). Blacks/African Americans comprised the largest proportion of HIV diagnoses in every age group.

By transmission category, among black/African-American males, male-to-male sexual contact was most frequently reported (61.1 percent), followed by heterosexual contact (23.1 percent), injection drug use (11.9 percent) and both IDU and male-to-male (3.6 percent). Among black/African-American females, most were exposed through heterosexual contact (85.2 percent), followed by IDU (14 percent).

Males ages 13-24 accounted for the largest proportion (30.9 percent) of HIV diagnoses among black/African-American males with infection attributed to male-to-male sexual contact, followed by males ages 25-34 (28.7 percent) and 35-44 (23.7 percent). Among black/African-American female diagnoses, the largest percentages were in those ages 35-44.

For more information about CDC efforts to address these disparities, visit: http://www.cdc.gov/hiv/aaa/ and http://www.nineandahalfminutes.org/.

CDC Reports Caregivers Who Practice Premastication Put Children at Risk

Premastication, or chewing foods or medicines before feeding to a child, is a route of HIV transmission through blood in saliva and has been associated with transmission of other pathogens, according to the CDC.

Approximately 14 percent of caregivers in the United States report premastication; however, the frequency of this behavior among HIV-infected caregivers is unknown.

For more information, visit MMWR: Premastication of Food by Caregivers of HIV-Exposed Children --- Nine U.S. Sites, 2009--2010.

NIH Reports New Drug Regimen Cut HIV Spread from Mother to Infant

A National Institutes of Health study found that adding one or two drugs to the standard treatment of infants after delivery from an HIV-positive woman can prevent mother-to-child transmission.

The CDC reports that one fifth of the people in the United States who have HIV are unaware of their status. From 100 to 200 infants are born with HIV in the U.S. each year, many to women who either were not tested in early pregnancy or who did not receive treatment during pregnancy.

The study reflects the rates of infection with infants who were given the standard zidovudine (ZDV) alone, ZVD and nevirapine (NVP) and those receiving ZVD plus lamivudine and nelfanavir. Results showed that treatment with the two- and three-drug regimens reduced HIV transmission by more than 50 percent.

For more information, visit New Drug Regimens Cut HIV Spread From Mother To Infant.

Drug regimen cuts HIV risks for breastfeeding infants

Giving breastfeeding infants of HIV-infected mothers a daily dose of nevirapine for six months halved the risk of HIV transmission to the infants at age 6 months, compared with giving infants the drug daily for six week, according to a study funded by the National Institutes of Health.

The longer nevirapine regimen achieved a 75-percent reduction in HIV transmission risk through breast milk for the infants of HIV-infected mothers with higher T-cell counts who had not yet begun treatment for HIV.

The primary analysis of the study data found that 2.4 percent of the infants who received six weeks of nevirapine had acquired HIV through breastfeeding by 6 months of age, but only 1.1 percent of the infants who received six months of nevirapine had acquired HIV through breastfeeding by that time – a 54-percent difference.

For more information, visit Six-Month Drug Regimen Cuts HIV Risk for Breastfeeding Infants, NIH Study Finds.

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