HIV, Mother to Child Transmission of HIV in Africa : To Overcome the Dilemmas

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1 ,**, The Japanese Society for AIDS Research The Journal of AIDS Research HIV Mother to Child Transmission of HIV in Africa : To Overcome the Dilemmas Naomi WAKASUGI Research Institute, International Medical Center of Japan : HIV. : 00 1/,**, UNAIDS +,**+.,*** HIV 1*,,2+*,,1** +/,,.**,*** HIV 2* 1* / +30*,/3 +,*** +33* +2* +320 /,*+*,, + HIV AIDS AIDS AIDS +,-,* +,,+* + HIV AIDS 3* - : +0, 20// +,+ + Fax : *- -,*, 1-0., nwakasu@ri.imcj.go.jp,**, + +/ HIV HIV HIV,,/ * /,... HIV 2. HIV Vulnerability + STI HIV Sex Sex Sex Purification, Drysex /

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3 N Wakasugi : Mother to Child Transmission of HIV in Africa + HIV + HIV STI, - Fidelity ; Teen age Safer sex Female genital mutilation, Dry sex, Purification, HIV ARV ARV ARV HIV 3 HIV, 2 +/ HIV +*, ++ HIV /* HIV +, CD. trophoblasts HIV +- HIV +. HIV HIV HIV HIV HIV +/

4 The Journal of AIDS Research Vol.. No.,,**,, 0 HIV IgGFc Immunogloblin G IgG HIV +/ HIV +2 HIV PCR Polymerase Chain Reaction +3,,* HIV proviral DNA PCR,+,- PCR - PCR,..,/,1 - DNA-PCR HIV PCR + day, 0 weeks +* weeks +/ PCR HIV +33. N. Engl. J. Med PACTG Pediatric AIDS Clinical Trials Group *10,2 Antiretroviral ; ARV ZDV +. 0 HIV,0 2 ARV ARV ARV,3 -* Trial -0 ARV Short course * /* ARV ARV +.. HIV STI VitA HIV,* M HIV CD. T HIV subtype 03 +1

5 N Wakasugi : Mother to Child Transmission of HIV in Africa - HIV ARV / Exclusive Breast Feeding HIV +, ph CD. HIV - IgA, G, Lactoferin, Lysozyme, Macrophage. Subclinical Mastitis tight junction,/,+.-, Epoch-making Nevirapine ; NVP Exclusive Breast Feeding -/ NVP HIVNET*+,trial NVP -0,** mg 1, NVP, mg kg + ZDV. Stigma,02 US NVP. US -1 HIV + -2 UNICEF 1* +2

6 The Journal of AIDS Research Vol.. No.,,**, -*,* -3 HIV AIDS HIV +, Stigma - Stigma. / 0 / 0 HIV.* HIV -/.+ HIV HIV.,,.- Melanie M Smith.. / IgA HIV ph 0 HIV +, - HIV. / 0 Clinical & subclinical Mastitis Subclinical Mastisis./ HIV HIV.0-3 HIV 0 HIV Feeding counseling UNICEF, +33. PACTG*10 HIV ARV ARV Elective Cesarean Section

7 N Wakasugi : Mother to Child Transmission of HIV in Africa +.+ ARV ARV ARV ARV -0 ARV ARV HIV HIV HIV HAART Highly Active Anti Retroviral Therapy Test for what? Stigma HIV vs vs,**+. +. US + NVP HIV ,* 0.2 NVP WHO UNAIDS UNICEF UNFPA HIV NVP,*** +* , /* HIV HIV +, ARV 1 +,.* US + 1,***,*,*** US HAART,** NVP Single dose ARV NDV Short course from -0 w HAART + year Tritherapy. US,02 US 1,***,*,*** US +,.* US 1,,*

8 The Journal of AIDS Research Vol.. No.,,**, -3,**+. 3* EU +331,**+ 0 1* +** ARV AIDS UNAIDS HIV HIV Voluntary Counseling & Testing : VCT VCT /* VCT HIV HIV HIV VCT VCT HIV ARV + AIDS Epidemic update December,**+.UNAIDS,**,., Per cent of infant deaths due to AIDS, projections for the year,*+*.the progress of nations.unicef Peckham C, Gibb D : Current concepts : Mother-to child transmission of the human immunodeficiency virus.n Engl J Med --- :,32 -*,, +33/.. Padian NS, Shiboski SC, Glass SO Vittingho# E:Heterosexual transmission of Human Immunodeficiency Virus (HIV) in northern California : Results from a ten-year study.am J Epidemiol +.0 : -/* -/1, / Zambia sexual behaviour survey +332.Central statistical o$ce, Ministry of Health Zambia, :FGM +- : 0/ Piot P, Laga M : Epidemiology of AIDS in the developing world.in Textbook of AIDS Medicine.Baltimore, MD, Williams & Wilkins, p +*3 p +-,, Closing the condom gap.population Reports Johns Hopkins School of Public Health, Vol,0, Series H, Number 3, April Remington JS, Klein JO : Infectious Diseases of the Fetus and Newborn Infant. /th edition.w.b.saunders Company,,**+. +* Lewis SH, Reynolds KC, Fox HE : HIV-+ in trophoblastic and villous Hofbauer cells, and hematological precursors in 2 week old fetuses.lancet --/ : /0/ /02, +33*. ++ Sprecher S, Soumenko# G, Puissant F, Degueldre M : Vertical transmission of HIV in +/-week fetus.lancet, :,22, , Langston C, Lewis DE, Hammill HA : Excess intrauterine fetal demise associated with maternal human immunodeficiency virus infection.j Infect Dis +1, : +./+ +.0*, +33/. +- Amiehessami-Aghili N, Spector SA : Human immunodeficiency virus type + infection of human placenta : Potential route of fetal infection.j Virol 0/ :,,-+,,-0, Kovacs A, Chan LS, Chen ZC, William AM, Muderspach L, Young M, Anastos K, Levine AM : HIV-+ RNA in plasma and genital tract secretions in women infected with HIV-+.J Acqui Immun Defic Syndr,, : +,. +-+, / Colebunders R, Kapita B, Nekwei W : Breastfeeding and transmission of HIV.Lancet, : +.21, ,+

9 N Wakasugi : Mother to Child Transmission of HIV in Africa +0 Lepage P, Van de Perre P, Carael M:Postnatal transmission of HIV from mother to child. Lancet, :.**, Zeigler JB, Cooper DA, Johnson RD, Gold J : Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet + : , +32/. +2 Bobat R, Coovadia H, Coutsoudis A, Moodley D : Determinants of mother to child transmission of human immunodeficiency virus type + infection in a cohort from Durban, South Africa. Pediatr Infect Dis J +/ : 0*. 0+*, Bremer JW, Lew JF, Cooper E, Hillyer GV, Pitt J, Handelsman E, Brambilla D, Moye J, Ho# R : Diagnosis of infection with human immunodeficiency virus type + by a DNApolymerase chain reaction assay among infants enrolled in the Women and Infants Transmission Study. J Pediatr +,3 : +32,*1, +330.,* Delamare C, Burgard M, Mayaux MJ, Blanche S, Doussin A, Ivano# S, Chaix ML, Khan C, Rouzioux C, and the French Pediatric HIV Infection Study Group : HIV-+ RNAdetection in plasma for the diagnosis of infection in neonates. J Acqui Immun Defic Syndr +/ : +,+ +,/, +331.,+ Bertolli J, St. Louis ME, Simonds RJ, Nieburg P, Kamenga M, Brown C, Tarande M, Quinn T, Ou CY : Estimating the timing of mother to child transmission of human immunodeficiency virus in a breast-feeding population in Kinshasa, Zaire. J Infect Dis +1. : 1,, 1,0, +330.,, Zijenah L, Mbizvo MT, Kasule J, Nathoo K, Munjoma M, Mahomed K, Maldonado Y, Madzime S, Katzenstein D : Mortality in the first, years among infants born to human immunodeficiency virus-infected women in Harare, Zimbabwe. J Infect Dis +12 : +*3 ++-, +332.,- Kevin MD, Fowler MG, Mercier E, Vincenzi I, Saba J, Ho# E, Alnwick DJ, Rogers M, Sha#er N : Prevention of mother to child HIV transmission in resource-poor countries. JAMA,2- : ++1/ ++2,,,***.,. The Working Group on Mother-to-Child Transmission of HIV : Rates of mother-to child transmission of HIV- + in Africa, America, and Europe : results from +- perinatal studies. J Acqui Immun Defic Syndr 2 : /*0 /+*, +33/.,/ Bulterys M, Chao A, Dushimimana A : Multiple sexual partners and mother-to-child transmission of HIV-+. AIDS 1 : /, +33-.,0 Lepage P, Van de Perre P, Msellati P : Mother-to-child transmission of human immunodeficiency virus type + and its determinants : Acohort study in Kigali, Rwanda. Am J Epidemiol +-1 : /23 /33, +33-.,1 John CG, Nduati R, Mbori-Ngacha D : Genital shedding of HIV-+ during pregnancy : association with immunosuppression, abnormal cervical or vaginal discharge, and severe vitamin Adeficiency. J Infect Dis +1/ : /1 0,, +331.,2 Connor EM, Sperling RS, Gelber R : Reduction of maternal-infant transmission of human immunodeficiency virus type + with zidovudine treatment. N Engl J Med --+ : *, +33..,3 Lallemant M, Jourdain G, Le Coeur S : Atrial of shortened zidovudine regimens to prevent mother-to-child transmission of human immunodeficiency virus type +. Perinatal HIV prevention trial (Thailand) investigators. N Engl J Med -.- : 32, 33+,,***. -* Moodly D : On behalf of the SAINT trial : Nevirapine (NVP) versus zidovudine(zvd) lamivudine(-tc) in prevention of peripartum HIV transmission, Abstract LbOr,, +- th International AIDS Conference, Durban, South Africa, 3 +. July,***. -+ Van de Perre P, Simonon A, Msellati P : Postnatal transmission of human immunodeficiency virus type + from mother to infant. Aprospective cohort study in Kigali, Rwanda. N Engl J Med -,/ : /3- /32, , Maguire A, Sanchez E, Fortuny C, Casabona J : Potential risk factors for vertial HIV-+ transmission in Catalonia, Spain : the protective role of cesarean section. The working group on HIV-+ transmission in Catalonia. AIDS ++ : +2/+ +2/1, Nicoll A, Newell ML, Peckham CS : Breast feeding is a major factor in HIV transmission. BMJ -,+ : 30-,,***. -. Guay LA, Musoke P, Fleming T, Bagenda D, Allen M, Nakabiito C, Sherman J, Bakaki P, Ducar C, Deseyve M, Emel L, Mirochnick M, Fowler MG, Mofenson L, Miotti P, Dransfield K, Bray D, Mmiro F, Jackson JB : Intrapartum and neonatal single-dose nevirapine compared with Zidovudine for prevention of mother-to-child transmission of HIV-+ in Kampala, Uganda : HIVNET *+, randomised trial. Lancet -/. : 13/ 2*,, / Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM, for the South African Vitamin A Study Group : Method of feeding and transmission of HIV-+ from mothers to children by +/ months of age : prospective cohort study from Durban, South Africa. AIDS +/ : 1.,,

10 The Journal of AIDS Research Vol.. No.,,**, ,,**+. -0 Mirochnick M, Clarke DF, Dorenbaum A : Nevirapine Pharmacokinetic considerations in children and pregnant women. Clin Pharmacokinet -3 :,2+,3-,,***. -1 Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P, Fowler MG, Jackson JB : Cost e#ectiveness of singledose nevirapine regimen for mothers and babies to decrease vertical HIV-+ transmission in sub-saharan Africa. Lancet -/. : 2*- 2*3, WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality : E#ect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries : a pooled analysis. Lancet -// :./+.//,,***. -3 Bassett MT : Psychosocial and community perspectives on alternatives to breastfeeding. Ann N Y Acad Sci 3+2 : +,2 +-/,,***..* Nduati R, John G, Mbori-Ngacha D : E#ect of breast feeding and formula feeding on transmission of HIV-+ A randomized clinical trial. JAMA,2- : ,***..+ King FS : Helping Mothers to Breastfeed. + st edition +32/. Association for Consumers Action on Safety and Health.., Georgeson J, Filteau S : Physiology, immunology, and disease transmission in human breast milk. AIDS PA- TIENT CARE and STDs. +. : /-- /-3,,***..- Short and long term e#ects of breast feeding on child health, (Koletzko B, Michaelsen KM, Hernell O eds), Advances in Experimental Medicine and Biology, vol.12. Kluwer Academic/Plenum Publishers,,***... Smith MM, Kuhn L : Exclusive breast-feeding : Does it have the potential to reduce breast-feeding transmission of HIV-+? Nutrition Reviews /2 : *,,***../ Willumsen JF, Filteau SM, Coutsoudis A, Uebel KE, Newell KE, Tomkins AM : Subclinical mastitis as a risk factor for mother-infant HIV transmission. Advances in Experimental Medicine and Biology.12 :,++,,-,,***..0 Nduati R, Richardson BA, John G : E#ect of breastfeeding on mortality among HIV-+ infected women : a randomized trial. Lancet -/1 : +0/+ +0//,,**+..1 Riley LE, Greene MF : Elective cesarean delivery to reduce the transmission of HIV. N Engl J Med -.* : +*-, +*--, Jackson JB, Becker-Pergola G, Guay L : Identification of the K+*-N mutation in Ugandan women receiving nevirapine to prevent HIV-+ vertical transmission. AIDS +. : /,,***..3 New Data on the Prevention of Mother-to-Child Transmission of HIV and their Policy Implications. Conclusions and recommendations. WHO Technical Consultation on behalf of the UNFPA/UNICEF/WHO/ UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV. Geneva, October,***. /* Eshelman SH, Mrancna M, Guay LA, Deseyve M, Cunningham S, Mirochnick M, Musoke P, Fleming T, Fowler MG, Mofenson LM, Mmiro F, Jackson JB : Selection and fading of resistance mutation in women and infants receiving nevirapine to prevent HIV-+ vertical transmission (HIVNET*+,). AIDS +/ : +3/+ +3/1,,**+. 1/,-

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