14 April 2010
By Anuradha Mascarenhas
IT is about a promise. Promoting Maternal and Infant Survival Everywhere (PROMISE) a study to answer some of the important global public health questions on prevention of mother to child transmission of HIV (PMTCT), is being undertaken under the leadership of BJ Medical College dean Dr Arun Jamkar. The medical college is one of the sites of this multi–centric study.
Despite the progress made in the treatment of HIV/AIDS the risk of mother to child transmission of HIV remains high. Worldwide, more than 17 million women of reproductive age are infected with HIV and less than 10 percent of these women receive PMTCT interventions.
Over half a million new pediatric HIV infections occur annually, with more than 200,000 occurring during breastfeeding, researchers attached to the project said.
While Dr Pradeep Sambrey and Dr Sandhya Khadse from BJMC are the principal investigators. The project had been submitted to the Indian Council of Medical Research (ICMR) for approval. Recently the community advisory board and institutional review board approved the study, researcher with the Johns Hopkins University and BJMC project co–ordinator Dr Nishi Suryavanshi said. What the study aims to look at is whether a single antiretroviral (ARV) regimen is more or less safe and effective as a triple ARV regimen in reducing the risk of transmission. “Basically the study investigates what is the best way to prevent HIV during pregnancy,” says Jamkar. According to the researchers a triple combination of drugs to prevent HIV among pregnant mothers is commonly given in USA and Europe.
Mother–to–child transmission is when an HIV–infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery or breastfeeding. Without treatment, around 15–30 per cent of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. The standard therapy for the prevention of HIV infection in infants includes zidovudine (ZDV) prior to the onset of labour, a single dose of nevirapine (NVP) for women during labour and a single dose of NVP for newborns given 72 hours after birth.
However under the WHO’s new guidelines in 2009, all HIV positive mothers, identified during pregnancy, should receive an extensive course of antiretroviral drugs to prevent mother to child transmission.
If these extensive drugs are not available, then the 2006 recommended course might be an option. Now this study will examine whether a combination of three drugs is most effective and around 60 HIV pregnant mothers whose CD4 count is more than 350 will be selected. Other study sites include Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe.
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