1. Eliminating Pediatric HIV/AIDS, and Caring for Children with HIV Dr. Laura Guay Vice President of Research Elizabeth Glaser Pediatric AIDS Foundation IAS 2011 Media Training & Briefing July 16, 2011 Rome, Italy

2. Elizabeth Glaser

3. Ariel and Jake Glaser

4. The Elizabeth Glaser Pediatric AIDS Foundation - 1988

5. HIV Disease Course

7. When exposed to HIV (or any infection) the body makes antibodies to fight the infection

8. Standard HIV tests measure these antibodies (EIA, rapid tests, western blot)

9. HIV antibodies from an HIV-infected woman cross the placenta and enter the baby’s blood

10. HIV detection tests

11. These tests measure the actual parts of the HIV virus itself (PCR, p24 antigen, viral culture)

14. 600 000 500 000 400 000 300 000 200 000 100 000 0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year This bar indicates the range New Global HIV Infections among Children, 1990–2007

15. Provision of Antiretroviral Drugs, 2004-2009 WHO, UNAIDS, UNICEF - Towards Universal Access: Progress Report 2009

16. Review of Latest Data - 2009 New Global HIV Infections among Children: 370,000 children were infected with HIV – More than 1,000 children EVERY DAY Provision of Antiretroviral Drugs: 53 % of pregnant women living with HIV received ARVs - 47% did NOT 35% of infants born to pregnant women living with HIV received ARVs – 65% did NOT

18. Provides opportunity for prevention of HIV infection in children

19. Provides opportunity for entry point into HIV Care for large number of HIV-infected women and their infected infants

21. Timing of HIV transmission to the infant During pregnancyAround labor/deliveryDuring Breastfeeding

22. If women and newborns take 1 dose of the drug nevirapine around the time the baby is born - - only ~16 out of 100 babies will getHIV from their mothers.

23. If women and newborns take a combination of HIV drugs during pregnancy and after delivery - - as few as 4-6 out of 100 babies will get HIV from their mothers.

24. Breast Feeding vs Bottle Feeding

25. 2010 Revised WHO Guidelines

27. Start ARV prophylaxis earlier in pregnancy

28. Provide ARV prophylaxis during breastfeeding

29. Provide single drug Nevirapine daily to infants OR

30. Provide three drug ARV prophylaxis to the mother

31. National authorities should decide whether MCH services will recommend HIV-infected mothers to:

32. Breastfeed and receive ARV interventions OR

33. Avoid all breastfeeding(Taking into account socioeconomics, health services, and local infant mortality and under-nutrition)

35. Allows early identification of children who will benefit from antiretroviral treatment, appropriate infant feeding choices, prophylaxis, and close medical follow-up

36. Decreases the psychological stress of uncertainty for the parents

37. HIV detection tests must be used in first 12-18 mos., then standard antibody tests are accurate

40. Early identification of complications and their appropriate management

41. Use of antiretroviral therapy to maintain and restore the immune system

42. Provision of support for HIV-infected persons, including psychosocial

43. Engage patients/families in HIV care and prevention through education, support and outreach

45. Vitamin A Supplementation

46. General Health Education (safe water, bednets)

47. Management of Diarrhea

48. Growth Monitoring & Nutrition Education - Early intervention/support

50. Studies in infants showed that there was a ~75% decrease in death when ART was started immediately rather than waiting

51. WHO revised recommendations in April 2008 such that ALL infants < 1 yr diagnosed with HIV infection should receive ART immediately

53. Negotiating PMTCT Activities (PMTCT = MCH)

55. Community sensitization/mobilization lacking

56. Integration of PMTCT within antenatal clinics can be difficult

57. Access to women who don’t deliver in health facilities

58. Very low numbers of male partners involved

59. Inadequate infant feeding education