March 10, 2017
This week, a study reviews how Thailand eliminated nearly all mother-to-child transmission of HIV. Another study finds that maraviroc (Selzentry, MVC) is safe and well tolerated as pre-exposure prophylaxis (PrEP). And an editorial in The Lancet HIV argues that resurrecting the federal funding ban on organizations that provide abortion services could slow progress against HIV. To beat HIV, you have to follow the science!
As of 2015, Thailand had virtually eliminated mother-to-child transmission of HIV, a narrative review published in Paediatrics and International Child Health noted.
Several initiatives contributed to that outcome. A radio and television campaign in the early 1990s broadcast hourly brief spots about HIV prevention. At the same time, a government-sponsored peer education program in schools, as well as various civil society campaigns, promoted condom use. These included a national "100% Condom Program" aimed at commercial sex workers, which also provided free condoms. Another strategy was the provision of free infant formula to mothers living with HIV to discourage breastfeeding in that group.
Donation campaigns raised funds to provide free zidovudine (AZT, Retrovir) to pregnant women living with HIV. That treatment regimen was later updated to reflect newer standards of care. Since 2000, HIV testing has been included in routine prenatal care, and all services for the prevention of mother-to-child transmission of HIV are paid for under Thailand's universal health coverage. Such coverage is facilitated by laws permitting the noncommercial production of generic antiretrovirals in Thailand, a related press release noted.
Maraviroc was well-tolerated as PrEP in a Phase II clinical trial The Journal of Infectious Diseases reported.
Five of the 406 study participants acquired HIV during the 48-week trial, but four of them had low or undetectable levels of the study drug when they tested positive for HIV. The fifth person had inconsistent drug levels at study visits prior to seroconversion. Even so, adherence to the study regimen was generally high, with more than 75% of plasma samples tested containing the study drugs.
The four study arms compared maraviroc alone, and combined with emtricitabine (FTC), tenofovir disproxil fumarate (TDF), and the combination of TDF plus FTC (Truvada) that is currently the only approved PrEP formulation. The trial only enrolled men who have sex with men and transgender women, all of whom reported at least once having condomless anal intercourse with a man who is living with HIV or whose serostatus is unknown. These results show that PrEP containing MVC should be studied further, the researchers concluded.
Resurrecting the prohibition against U.S. funding of international organizations that provide information about abortion "could turn the clock back on years of progress made" against HIV, The Lancet HIV writes in an editorial.
The "Mexico City policy," originally instituted in 1984 by President Ronald Reagan, had been rescinded by Presidents Bill Clinton and Barack Obama. President Donald Trump re-instituted it on January 22, 2017. The rule applies to all international nongovernmental organizations, even if they use non-U.S. money to provide abortion advice, and provide mainly other reproductive health services, such as HIV testing or prenatal care.
It is also unclear whether the previous exemption from this rule for the U.S. President's Emergency Plan for AIDS Relief will continue under the current U.S. administration, the journal writes. The threatened defunding of Planned Parenthood means reproductive health services in the U.S. -- including HIV care --. are at risk as well, it adds. The Lancet calls the restriction on money for global reproductive health, "an attempt to suppress reproductive health services for women worldwide."
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