Sunday, April 18, 2010

Expectant HIV/Aids women to start on ARV earlier - WHO

By Halima Abdallah
Posted Monday, April 19 2010 at 00:00

HIV-positive pregnant women will now start on antiretroviral in the 14th week of their pregnancy, according to World Health Organisation’s revised guideline on prevention of mother to child transmission of HIV.
The revised guidelines, based on those of 2006, recommend that all HIV-positive pregnant women be given ARVs starting at 14 weeks and continuing through the end of the breastfeeding, to reduce the risk of HIV transmission and improve the infant’s chance of survival. An earlier start to antiretroviral treatment boosts the immune system and reduces the risks of HIV-related diseases and deaths. 
The 2006 guidelines recommended antiretroviral therapy (ART) in the third trimester (beginning at 28 weeks). At the time, there was insufficient evidence on the protective effect of ARVs during breastfeeding. However since then, studies and trials have demonstrated that starting ARV earlier reduces rates of death and disease and increases the efficacy of ARVs in preventing transmission to the infant while breastfeeding.
The latest guideline issued in November 2009, recommends that mothers should continue breastfeeding even when they are positive as they take the drugs with their babies.
“We did a study in National Referral Hospital Mulago and found that the risks of death were higher in those children who were not breastfed because they were prone to diseases like diarrhoea,” Ministry of Health Principal Medical Officer in charge of Child Health Jessica Sabiti said.
The guidelines also recommend that once a mother has selected breastfeeding or providing formula milk, she should do so exclusively and not mix the two. She can choose to boil the breast milk up to 60 degrees, before feeding it to the baby.
“Mixing breast milk and other formula milk enhances transmission because formula feeds causes perforation in the baby’s digestive system when given too early. When the baby is breastfed, the mother’s milk that contains the virus infiltrates the baby’s body through the perforations,” Jessica said.

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