Rene Ekpini

Bio: Rene Ekpini is an academic researcher from World Health Organization. The author has contributed to research in topics: Nevirapine & Regimen. The author has an hindex of 5, co-authored 5 publications receiving 915 citations.

What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs

Abstract: Background The number of HIV-positive pregnant women receiving antiretroviral drugs (ARVs) to prevent mother-to-child transmission (MTCT) of HIV has increased rapidly. Objective To estimate the reduction in new child HIV infections resulting from prevention of MTCT (PMTCT) over the past decade. To project the potential impact of implementing the new WHO PMTCT guidelines between 2010 and 2015 and consider the efforts required to virtually eliminate MTCT, defined as Methods Data from 25 countries with the largest numbers of HIV-positive pregnant women were used to create five scenarios to evaluate different PMTCT interventions. A demographic model, Spectrum, was used to estimate new child HIV infections as a measure of the impact of interventions. Results Between 2000 and 2009 there was a 24% reduction in the estimated annual number of new child infections in the 25 countries, of which about one-third occurred in 2009 alone. If these countries implement the new WHO PMTCT recommendations between 2010 and 2015, and provide more effective ARV prophylaxis or treatment to 90% of HIV-positive pregnant women, 1 million new child infections could be averted by 2015. Reducing HIV incidence in reproductive age women, eliminating the current unmet need for family planning and limiting the duration of breastfeeding to 12 months (with ARV prophylaxis) could avert an additional 264 000 infections, resulting in a total reduction of 79% of annual new child infections between 2009 and 2015, approaching but still missing the goal of virtual elimination of MTCT. Discussion To achieve virtual elimination of new child infections PMTCT programmes must achieve high coverage of more effective ARV interventions and safer infant feeding practices. In addition, a comprehensive approach including meeting unmet family planning needs and reducing new HIV infections among reproductive age women will be required.

Antiretroviral regimens for preventing HIV infection in infants

Abstract: Several initiatives have been launched to reinforce countries’ efforts to scale up programmes for the prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) infection, though the shift from donor-funded projects and limited ini-tiatives towards nationwide programmes is very slow. Coverage of PMTCT programmes and uptake of services pro-vided through them are still very low worldwide (1).Provision of antiretroviral (ARV) drugs to mothers and infants is one of the key interventions for the prevention of HIV infection in infants. Various short-course ARV regimens have been shown to reduce significantly HIV peri-partum transmission in both breast-feeding and non-breastfeeding popula-tions in resource-constrained settings (2–5). Pilot programmes have been implemented to offer these interven-tions to a large number of women and infants, with varying degrees of success. Concerns have been raised, however, about their mid-term and long-term effectiveness at population level. In sub-Saharan Africa where breastfeed-ing is the norm, their overall efficacy is diminished, but not outweighed, over time by postnatal transmission through breastfeeding (6). So far, single-dose nevirapine (NVP) has been considered to be the most cost-effective regimen in settings where antenatal care coverage is low and where pregnant women do not present until late in pregnancy. Recent evidence strongly supports the use of combination regimens, especially short- course zidovudine (AZT) and single-dose NVP, to achieve a more dramatic reduction in perinatal transmission of HIV (7, 8). That combination regimen is now recommended as one of the simplest, highly efficacious regimens, but its large-scale introduction has been problematic (9, 10).The article in this issue by David Coetzee et al. (pp. 489–494) focuses

Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis

Abstract: OBJECTIVES: To synthesize the evidence on the risk of HIV transmission through unprotected sexual intercourse according to viral load and treatment with combination antiretroviral therapy (ART). DESIGN: Systematic review and meta-analysis. METHODS: We searched Medline, Embase and conference abstracts from 1996-2009. We included longitudinal studies of serodiscordant couples reporting on HIV transmission according to plasma viral load or use of ART and used random-effects Poisson regression models to obtain summary transmission rates [with 95% confidence intervals, (CI)]. If there were no transmission events we estimated an upper 97.5% confidence limit. RESULTS: We identified 11 cohorts reporting on 5021 heterosexual couples and 461 HIV-transmission events. The rate of transmission overall from ART-treated patients was 0.46 (95% CI 0.19-1.09) per 100 person-years, based on five events. The transmission rate from a seropositive partner with viral load below 400 copies/ml on ART, based on two studies, was zero with an upper 97.5% confidence limit of 1.27 per 100 person-years, and 0.16 (95% CI 0.02-1.13) per 100 person-years if not on ART, based on five studies and one event. There were insufficient data to calculate rates according to the presence or absence of sexually transmitted infections, condom use, or vaginal or anal intercourse. CONCLUSION: Studies of heterosexual discordant couples observed no transmission in patients treated with ART and with viral load below 400 copies/ml, but data were compatible with one transmission per 79 person-years. Further studies are needed to better define the risk of HIV transmission from patients on ART.