"These findings," NIAID stated in a recent bulletin, "provide clear evidence in support of the current World Health Organization recommendation that HIV-infected infants who have received NVP at birth should be started on an LPV/r-based treatment regimen whenever possible."
But here's the rub: LPV/r is a relatively expensive drug more available in the developed than the developing world, and it must be kept cold a challenge in sub-Saharan Africa and much of India. On the other hand, NVP is relatively cheap and accessible in developing nations.
Breast-feeding presents another challenge: While it can lead to infection of the infant of an HIV-positive mother, the mother's milk also protects the child against many common infections of infancy, Palumbo says. Also, formula feeding to prevent transmission of HIV a common practice in the developed world leaves infants prone to suffer from upper-respiratory infections, diarrhea, and other maladies. According to estimates of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), more than nine million children younger than 5 are expected to die each year 17 percent from pneumonia, 17 percent from diarrhea, and 7 percent from malaria, as opposed to 1.5 percent from HIV/AIDS. At least 10 percent of enrollees in the IMPAACT study already are or may be suffering from tuberculosis.
That's why, as the trial continues, IMPAACT will examine whether NVP becomes effective again in HIV-positive children after a certain age.
"There's a big, dynamic struggle going on as we speak," Palumbo says. "We're right in the middle of this active debate. The question is, how fast can we do it? Can scientific mandates be translated into practice? Those data are going to be used to inform the prevention and treatment guidelines at WHO. I still don't know how it's going to play out." Palumbo also serves as
|Contact: David Corriveau|