NAM feedback from AIDS 2016 Gareth Tudor-Williams Imperial College Healthcare NHS Trust St. Mary’s Hospital & Imperial College LONDON, UK g. tudor-williams@imperial. ac. uk
8 th International Workshop on HIV Pediatrics 15 -16 th July 2016 Durban, S. Africa
Prevention of vertical transmission targets (Prof Mugyeni) 99% Pregnant mothers identified and Rx EID Early infant diagnosis 99% Infected children on Rx
Malawi 2011: Option B+ • Start HAART for any women identified as HIV+ in pregnancy and continue for life • Simplifies PMTCT programme requirements - no need for CD 4 testing or need to stop ART after pregnancy • Extended protection to prevent vertical transmission in future pregnancies • Protection from sexual transmission to partners • Benefit to woman’s health • More costly in short-term, but likely cost-effective over time
AIDS 2016: Option B+ • Chewe Luo (UNICEF) plenary • By 2015, 21 of the 22 target LMIC had adopted Option B+ • S. Africa was relatively late to adopt the strategy but has rolled this out very effectively • Which country in SSA has not yet got it’s act together? . .
October 2015 report
The PROMISE trial – 3 randomisations Antepartum (14 wks-term) Labor/ Delivery Maternal CD 4 >350 Postpartum (for duration of BF) Maternal Health (after BF cessation) Infant uninfected at birth (Version 2. 0) R a n d o m i z e ZDV + sd. NVP+ TRV ENROLLED 3, 529 WOMEN R a n d o m i z e Triple ARV Prophylaxis Mother R a n d o m i z e Continue Triple ARV Regimen Stop All ARVs Infant NVP Prophylaxis 11/4/2014 - DSMB stopped Antepartum Component for efficacy
The PROMISE trial – AIDS 2016 Antepartum (14 wks-term) Labor/ Delivery Maternal CD 4 >350 Postpartum (for duration of BF) Maternal Health (after BF cessation) Infant uninfected at birth (Version 2. 0) R a n d o m i z e ZDV + sd. NVP+ TRV ENROLLED 3, 529 WOMEN R a n d o m i z e Triple ARV Prophylaxis Mother R a n d o m i z e Continue Triple ARV Regimen Stop All ARVs Infant NVP Prophylaxis Taha et al: 0. 6% transmission at 12 m regardless of arm
Breast feeding controversies
EID
Adolescents
TUSS 06 – New evidence: why do young women in Africa have higher rates of HIV infection? • T de Oliviera • phylogenetic mapping: 1, 500 viruses sequenced. • Included an infant whose mother was HIV uninfected. Checked family members: incredibly tightly linked virus found in one of the aunts. Turned out she had breast fed the baby when mum went back to work. Proof that the methodology was working.
T de Oliviera • 202 linked clusters identified • possible to identify one partner monogamous partnership, and clusters of eg 5 males and 11 women. Knew ages ad sex of individuals from whom samples were obtained. • Enabled linkage analysis to show that girls aged 15 -19 were linked to men on average 11 years older than them.
Adam Burgener / Nichole Klatt • Biological factors affecting Pr. EP: ? role of vaginal microbial dysbiosis • in vitro experiments confirmed that gardnerella could reduce TDF concentration in supernatant by 70% over 24 hours compared with lactobacilli • Mechanism still being assessed
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