HIV research outpost uncovers shortcomings in treatment for African babies

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Only about half of HIV-exposed infants in some African countries receive a minimal dose of the prevention drug nevirapine, say UAB researchers who also treat patients in Zambia.

A recent UAB study underscores the need to expand programs that strive for global pediatric AIDS control.
The drug is prescribed to prevent mother-to-child transmission of human immunodeficiency virus (HIV), but a report in the July 21 issue of the Journal of the American Medical Association concludes that only 51 percent of HIV-exposed infants received the minimal regimen to protect them. The study also said no sign of the drug was evident in the umbilical cord samples from most of the women who had been prescribed nevirapine while pregnant.

"This study shows us there are programmatic failures and common problems that occur along the path to mother-to-child transmission prevention," including testing inadequacies and the failure of patients to take the medications, says Elizabeth Stringer, M.D., UAB associate professor of obstetrics and gynecology and the lead author of the study. Stringer treats patients and conducts research full-time at the UAB-affiliated Center for Infectious Disease Research in Zambia with her husband Jeffrey Stringer, M.D., who directs the center. Both are members of UAB's Center for AIDS Research.

Nevirapine is the backbone of anti-HIV therapy in the developing world, but its usefulness is limited by how many infected and at-risk persons receive the drug, researchers say. The UAB study underscores the need to expand programs for global pediatric AIDS control and incorporate ongoing monitoring and quality improvements into all nevirapine-based care programs.

More than 30 million people globally are infected with HIV; it leads to more than 2 million AIDS-related deaths each year. The World Health Organization has revised its international guidelines to standardize drug regimens to prevent mother-to-child HIV transmission.

"We know that true mother-to-child transmission prevention begins with HIV testing -finding those who are infected and getting them into a program helps them adhere to the single-dose nevirapine and other care guidelines," Stringer says.

The research is a collaboration among many partners: UAB; the U.S. Centers for Disease Control and Prevention Division of HIV/AIDS Prevention and Global AIDS Program; Centers for Infectious Disease Research in Lusaka, Zambia; Cameroon Baptist Convention Health Board; Elizabeth Glaser Pediatric AIDS Foundation; Centre Hospitalier Universitaire de Treichville, Abidjan, Ivory Coast; University of Bordeaux; and University of Cape Town. Funding support for the study is provided by the CDC.

The study is based on cord samples from 27,893 mother-infant pairs treated at clinics in the African countries of Cameroon, Cote d'Ivoire, South Africa and Zambia. The samples are from 43 separate clinics where single-dose nevirapine is used.