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Use of Antiretroviral Drigs for Treating Pregnant Women and Preventing HIV Infection in Infants (PMTCT ARV Guidelines)

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Elizabeth Glaser Pediatric AIDS Foundation
Elizabeth Glaser Pediatric AIDS Foundation
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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Nathan Shaffer, PMTCT Team Leader, HIV Dept, WHO EGPAF Satellite, XVIII International AIDS Conference Vienna, July 20, 2010
Key Messages ,[object Object],[object Object],[object Object],[object Object]
Comprehensive approach to virtual elimination Childbearing Women Women living with HIV Pregnant women living with HIV HIV-infected children Prevent new infections Avoid unintended pregnancies Prevent MTCT
Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008 UNAIDS, AIDS Epidemic Update 2009 70,000 infections averted in 2008
3 Sets of Rapid Advice, Nov 2009
New 2010 WHO Guidelines Adult ART; PMTCT; HIV and Infant Feeding http://www.who.int/hiv/en/
Rationale for Development of New 2010 PMTCT Recommendations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Risk of Mother-to-Child HIV Transmission ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PMTCT ARV Recommendations Refer to Two Key Approaches ,[object Object],[object Object],[object Object],[object Object]
Special Concerns of Drugs for PMTCT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
1. ART for HIV+ Pregnant Women ,[object Object],[object Object],[object Object],[object Object],[object Object]
Antiretroviral therapy (ART) Start ART as soon as feasible regardless of gestational age CD4 cell count available CD4 < 350 cell/mm 3 CD4 > 350 cell/mm 3 ART Regardless of clinical stage ART If symptomatic (stage 3 or 4) WHO clinical stage Stage 1 ARV prophylaxis Stage 2 ARV prophylaxis Stage 3 ART Stage 4 ART
ART for mother and prophylaxis for exposed infants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Benefit and Impact of Providing ART to Eligible Pregnant Women ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2. ARV Prophylaxis to Prevent MTCT ,[object Object],[object Object],[object Object],[object Object],[object Object],For women not eligible for ART or unknown eligibility Begin as early as 14 weeks gestation (2nd trimester) or as soon as possible thereafter
ARV Prophylaxis Options *sd-NVP and AZT+3TC can be omitted if mother receives > 4 wks AZT antepartum Option A Option B ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Setting national or sub-national recommendations for infant feeding in the context of HIV ,[object Object],[object Object],[object Object],[object Object]
How long to breastfeed? ,[object Object],[object Object],[object Object]
Cost ,[object Object],[object Object],[object Object]
Option A or Option B? “ Both recommended options A and B provide significant reduction of the MTCT risk. There are advantages and disadvantages of both options, in terms of feasibility, acceptability and safety for mothers and infants, as well as cost. The choice for a preferred option should be made at a country level, after considering these advantages and disadvantages.”
Option A or Option B? Option A AZT to mother during pregnancy and NVP to infant during BF Option B Mother triple ARV during pregnancy and during BF ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Duration, timing and complexity of ARV regimens to reduce MTCT Maternal triple ARV prophylaxis sd-NVP sc AZT + sd-NVP Daily Infant NVP Maternal therapeutic ART sc AZT + sd-NVP
Guiding Principles ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Research Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Implementation Challenges
Support for Country Implementation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Summary: Benefits and Opportunities ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU ,[object Object],[object Object],[object Object],New recommendations available at: http://www.who.int/hiv/en/

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Use of Antiretroviral Drigs for Treating Pregnant Women and Preventing HIV Infection in Infants (PMTCT ARV Guidelines)

  • 1.
  • 2.
  • 3. Comprehensive approach to virtual elimination Childbearing Women Women living with HIV Pregnant women living with HIV HIV-infected children Prevent new infections Avoid unintended pregnancies Prevent MTCT
  • 4. Estimated number of new pediatric infections with and without PMTCT prophylaxis globally, 1996-2008 UNAIDS, AIDS Epidemic Update 2009 70,000 infections averted in 2008
  • 5. 3 Sets of Rapid Advice, Nov 2009
  • 6. New 2010 WHO Guidelines Adult ART; PMTCT; HIV and Infant Feeding http://www.who.int/hiv/en/
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Antiretroviral therapy (ART) Start ART as soon as feasible regardless of gestational age CD4 cell count available CD4 < 350 cell/mm 3 CD4 > 350 cell/mm 3 ART Regardless of clinical stage ART If symptomatic (stage 3 or 4) WHO clinical stage Stage 1 ARV prophylaxis Stage 2 ARV prophylaxis Stage 3 ART Stage 4 ART
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20. Option A or Option B? “ Both recommended options A and B provide significant reduction of the MTCT risk. There are advantages and disadvantages of both options, in terms of feasibility, acceptability and safety for mothers and infants, as well as cost. The choice for a preferred option should be made at a country level, after considering these advantages and disadvantages.”
  • 21.
  • 22. Duration, timing and complexity of ARV regimens to reduce MTCT Maternal triple ARV prophylaxis sd-NVP sc AZT + sd-NVP Daily Infant NVP Maternal therapeutic ART sc AZT + sd-NVP
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.