PEPFAR, UNAIDS call for an end to mother-to-child transmission of AIDS

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President Bill Clinton at the United Nations High Level Meeting on AIDS Thursday.

The second day of United Nations (UN) High-Level Meeting on AIDS activities culminated with an announcement by the head of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program representatives along with UNAIDS that they have set the goal of virtually eliminating mother-to-child transmission of AIDS by 2015.

At the star-studded afternoon session where the announcement was made, President Bill Clinton, Nigerian President Goodluck Jonathon, actress Naomi Watts, musical artist and UNAIDS Goodwill Ambassador Annie Lenox and others gathered to speak up for pregnant mothers and children affected by and infected with and at risk of HIV.

Twenty-two countries account for 90 percent of new pediatric HIV infections, most of which are in sub-Saharan Africa, Clinton said in his speech, adding that Cambodia is the example to follow in how to tackle the problem. In 2007, like many countries in Africa, antiretroviral therapy (ART) coverage for HIV-infected pregnant mothers was at most ten percent in Cambodia. Neither treatment nor care programs were taking responsibility for the prevention of mother-to-child transmission (PMTCT). The country decided to address the problem and launched a linked response program assigning joint responsibilities to maternal and child health providers and HIV service providers. Coverage rates have since expanded to more than 60 percent of infected mothers and infection rates have decreased significantly. They are on their way to eliminating pediatric AIDS just five years later, Clinton said.

Clinton also pushed for a move away from single-dose nevirapine, which he said is not as effective for the prevention of HIV transmission from mother to baby and the side effects are harmful for moms. Due to the cheap price of the drug, many countries, especially the 22 with the highest rates of MTCT, lack the resources to move away from nevirapine to other drugs.

The United States committed an additional $75 million to PMTCT in addition to the more than $300 million the PEPFAR program commits to PMTCT annually, said Eric Goosby, MD, the U.S. Global AIDS Ambassador. This $75 million will come from PEPFAR’s current budget, and Goosby did not clarify whether or not this will be an annual or one-time allocation.

UNAIDS and PEPFAR also issued a report “Countdown to Zero: Believe it. Do it.” Which outlines the global plan to eliminate new pediatric HIV infections and “keeping their mothers alive,” by ensuring they receive ART until they have finished breastfeeding. 

“In 2009, 370,000 children became newly infected with HIV globally and an estimated 42,000 to 60,000 pregnant women died because of HIV,” according to the report. “In contrast, in high-income countries the number of new HIV infections among children and maternal and child deaths due to HIV was virtually zero.” ART use among HIV-infected pregnant women can take the chance of passing the virus on to the child down to five percent or less.

(From left) GHI Executive Director Lois Quam, NIAID Director Dr. Anthony Fauci, White House AIDS Coordinator Jeffery Crowley, and U.S. Global AIDS Ambassador Dr. Eric Goosby at a UN High Level Meeting on AIDS side event Thursday.

Earlier Thursday morning, U.S. government representatives discussed the multifaceted U.S. response to the global HIV/AIDS epidemic at a briefing at the U.S. Mission to the UN.

“If we accept that science drives policy then we’re in a unique time today,” said Anthony Fauci, MD, director of the Institute of Allergy and Infectious Diseases at the National Institutes of Health, referring to the “slam dunk” HPTN 052 study results announced last month which showed that HIV treatment reduces an HIV-infected person’s risk of sexually transmitting the virus to their uninfected partner by more than 96 percent. Seventeen of the 27 infections reported in the study were transmitted among those with CD4 counts higher than 350 copies/mm3, Fauci said, which suggests a need to treat early to fully take advantage of the prevention benefit of ART.

“Science should drive policy… Here is the scientific data, now act to take advantage of it,” Fauci said. “Either you’re going to pay a lot now or you’re going to pay an awful lot later.” The study results have prompted many to call for a focused scale up of treatment to end AIDS.

When Fauci discussed the arsenal of combination prevention tools needed to tackle new infections, to include treating everyone we can, he noted medical male circumcision as another powerful prevention intervention that is now showing that 40 months after the procedure the HIV protection benefit remains strong, with a full 68 percent reduced risk of contracting HIV.

Goosby discussed the importance of getting other nations to increase their financial commitments to the battle against AIDS. “The only means through which we will address unmet need is an approach focused around efficiency and elimination of redundancy,” he said, as the current economic climate does not bode well for increased funding for global AIDS programs.

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