1) Monotherapy in PEP is not standard care in HIV post-prophylaxis management
2) Why does the scientific community not recommend to stop 4-weeks AZT treatment to newborns whose mothers have an undetectable HIV-viral load?
3) Is it due to a lack of evidence, or fear?
@ Brian:
1) Well ...this is not really 100% true (:-)!
The presence of virus -with an undetectable viremia!- not equal to infection for the sexually exposed partner (donor--> receiver) !!! We do know/have body of evidence that a HIV + donor partner with undetectable viral load will not infect a sexual receiver partner!
But the problem -the all issue!- here is 100% no risk plausibility!
2) Do you really think that these newborn escape from HIV infection thanks to AZT montherapy?
Don't think so... or not convinced at all.
I followed about 10 cases whose mothers and dad refused AZT montherapy for their newborn because of undetectable viral load in the mothers. Some mothers'HIV physician here in Geneva do not believe in AZT montherapy in this setting...
BIG time for a formal study (collection-reports of cases and meta-analysis)...becaus of course chances that a Ethics committee will allow boucle-blind is almost 100%, right?
Thank you both (Dorothy + Brian) and really hope other inputs will come.
Regards,
Alessandro
We need to know more about reservoirs too. What's stopping that undetectable viremia from crossing the fetoplacental unit and using the baby as a reservoir. Yes the mature immune system of a partner may escape but the vulnerable immune system of a fetus is risky.
'HIV Exposure Harms Infant Immunity' Maternal HIV Infection and Antibody Responses Against Vaccine-Preventable Diseases in Uninfected Infants JAMA, February 9, 2011—Vol 305, No. 6. this provocative paper suggestd that even in the uninfected HIV exposed infants antenatal HIV exposure was associated with lower specific antibody responses in exposed uninfected infants compared with unexposed infants at birth. would be good to stratify the mother infant pairs with undetectable versus detectable viral loads and see if there's a difference. needs some more exploration before we stop what may be working fine
Mothers have to be followed up regularly for their viral load,if we want to stop AZT in infants.Counselling to both parents about this should be given before taking up this step.Breastfeeding in these infants have to be recorded.
More evidence should be gathered.
@Tracy: Foeto-placental way of HIV infection for newborn is not the predominant way of infection. It is the birth canal! Do you agree?
People from the field : please join discussion and SHARE your opinion!
It is 3)
There is no evidence to stop - no controlled trial and people fear to stop PEP - since the PACT 076 in 1994 we shortened (in Berlin we did it 10 days iv) and now in the light of "undetecable viral load" the ce-section is an option and therefore to forget the PEP also. In the moment people fear it - but Christoph Rudin from the Swiss Cohort mentioned that they will start - perhaps it is worth to ask him [email address deleted]
Perhaps I was not clear: the question is in due course on the table. If people decide that "undetectable virus load" (whatever this means) allows vaginal delivery the PEP makes no sense. Till now we had a clear concept: ART before delivery depending from the health of the mother, c-section before labour and PEP
Now the concepts change not evidence-based and therefore the decisions are optional changing from country to country
Thank you Ilse!
You said it right! If vaginal delivery is allowed AZT mono therapy IS NON SENSE!
I know very well Christoph from Basel...We meet twice a year on Infectious disease Board.
I will push discussion forward.
Regards,
Alessandro
Thank you Alessandro too. Please push the discussion foreward - the Swiss people is always in front with new things - it was the same with c-section - first publication from Prof Kind et al in AIDS 1998
Have a good time
Regards
- Badges
- Science topic
- Similar topics
- Biological Science
- Immunology
- Antibodies