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HAART for all pregnant women
Nittaya Phanuphak (Thai Red Cross AIDS Research Centre, Bangkok, Thailand) discussed the implementation of HAART for all pregnant women. British and US guidelines recommend treating pregnant women who do not require ART for their own health with HAART [101,102]. The WHO guidelines, however, provide a second option of zidovudine with single-dose nevirapine (AZT plus sd-NVP), stating that both options have advantages and disadvantages in terms of feasibility, acceptability, safety and cost [103]. The Optimal Combination Therapy After Nevirapine Exposure (OCTANE) study showed inferior outcome after NVP- versus protease inhibitor (PI)-based HAART in women exposed to sd-NVP [1]. A Thai feasibility study showed that the transition to HAART for all HIV-infected pregnant women was acceptable and achievable. Administering HAART to all women can even simplify the management of this population, as there is no need for a CD4 result before initiating therapy or a tail regimen afterwards. There is no increase in adverse events with the use of HAART compared with AZT plus sd-NVP, and less non-nucleotide reverse-transcriptase inhibitor resistance. Finally, studies in several resource-limited countries have shown that HAART is more cost effective than AZT plus sd-NVP. Phanuphak concluded that these so-called disadvantages should be seen as challenges, and that developing countries should be encouraged to overcome these and strive for the best, which is to administer HAART to all pregnant women.
Management of children with HIV
There are over 2 million children estimated to be living with HIV globally; however, Elaine J Abrams (Columbia University, NY, USA) noted that pediatric HIV infection has been transformed from a fatal to a chronic disease. Key elements in the management of children are the local resources for health services, coverage and efficacy of prevention of mother-to-child transmission, availability of drugs in pediatric formulations and the developmental trajectory of children. The Children with HIV Early Antiretroviral Therapy (CHER) study provided evidence to support changes in WHO 2010 guidelines to initiate HAART in all infants [2]. The When to Start Anti-HIV Drugs in Children Infected With HIV (PREDICT) study results, to be announced in mid 2011, will provide important information on when to initiate HAART in older children [3]. Recent studies showed better virological outcome after PI- compared with NVP-based HAART in children exposed...