incident hiv infection in pregnancy/breastfeeding –...
TRANSCRIPT
Incident HIV Infection in
PregnancyBreastfeeding ndash Prevention Management
Daya Moodley (PhD) Womens Health and HIV Research Unit Nelson R
Mandela School of Medicine University of KwaZulu Natal South Africa
Definitions
bull Incident HIV Infection recently acquired
bull Acute HIV Infection Viraemia (10-20th day)
bull Early HIV Infection Seroconversion (30th -90th day)
UNAIDS Global AIDS Response Target 3
bull Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
05
101520253035404550
NoInterventions
NoBreastfeeding
Short CourseARV and
Breastfeeding
Short CourseARV and No
Breastfeeding
2 or 3 ARVS +CS and No
Breastfeeding
M
TC
T
MOTHER-TO-CHILD TRANSMISSION RATES
De Cock KM Fowler MG Mercier E et al JAMA 2000 283 1175-82
Prevention of MTCT in the US
15203350
76
245
0
10
20
30
40
1993 WITS
1994PACTG
076
1997PACTG
185
1999 WITS
2001PACTG
247
2002PACTG
316
T
rans
mis
sion
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Definitions
bull Incident HIV Infection recently acquired
bull Acute HIV Infection Viraemia (10-20th day)
bull Early HIV Infection Seroconversion (30th -90th day)
UNAIDS Global AIDS Response Target 3
bull Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
05
101520253035404550
NoInterventions
NoBreastfeeding
Short CourseARV and
Breastfeeding
Short CourseARV and No
Breastfeeding
2 or 3 ARVS +CS and No
Breastfeeding
M
TC
T
MOTHER-TO-CHILD TRANSMISSION RATES
De Cock KM Fowler MG Mercier E et al JAMA 2000 283 1175-82
Prevention of MTCT in the US
15203350
76
245
0
10
20
30
40
1993 WITS
1994PACTG
076
1997PACTG
185
1999 WITS
2001PACTG
247
2002PACTG
316
T
rans
mis
sion
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
UNAIDS Global AIDS Response Target 3
bull Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
05
101520253035404550
NoInterventions
NoBreastfeeding
Short CourseARV and
Breastfeeding
Short CourseARV and No
Breastfeeding
2 or 3 ARVS +CS and No
Breastfeeding
M
TC
T
MOTHER-TO-CHILD TRANSMISSION RATES
De Cock KM Fowler MG Mercier E et al JAMA 2000 283 1175-82
Prevention of MTCT in the US
15203350
76
245
0
10
20
30
40
1993 WITS
1994PACTG
076
1997PACTG
185
1999 WITS
2001PACTG
247
2002PACTG
316
T
rans
mis
sion
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
05
101520253035404550
NoInterventions
NoBreastfeeding
Short CourseARV and
Breastfeeding
Short CourseARV and No
Breastfeeding
2 or 3 ARVS +CS and No
Breastfeeding
M
TC
T
MOTHER-TO-CHILD TRANSMISSION RATES
De Cock KM Fowler MG Mercier E et al JAMA 2000 283 1175-82
Prevention of MTCT in the US
15203350
76
245
0
10
20
30
40
1993 WITS
1994PACTG
076
1997PACTG
185
1999 WITS
2001PACTG
247
2002PACTG
316
T
rans
mis
sion
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Prevention of MTCT in the US
15203350
76
245
0
10
20
30
40
1993 WITS
1994PACTG
076
1997PACTG
185
1999 WITS
2001PACTG
247
2002PACTG
316
T
rans
mis
sion
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Several Other Studies
bull SWEN-Uganda EthiopiaIndia ndash 69 bull PEPI-Malawi ndash 52 bull MITRA-Tanzania ndash 12 bull KIBS-Kenya ndash 26 bull And othershelliphellip
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
Source Aggregated data from HIV estimates files UNAIDS 2011
bull Limited access to HCT bull Limited access to optimal PMTCT interventions bull Limited access to ARV treatment
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
What are we missing
bull Misdiagnosis ndash POC tests with poor sensitivity
bull Window Period ndash seroconversion bull HIV acquisition subsequent to HCT
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Pregnancy Post Delivery
Uganda (Gray R Lancet 2005) 23100wy 13100wy
Zimbabwe (Dube S AIDS 2008) 48100wy
Tanzania (Urassa W Scand J Pub Hlth 2006) 3
Brazil (Nielsen K Retrovirol 2008) 02100wy
US (Birkhead Int Confr AIDS 2006) 531000wy
Botswana (Lu L 3rd HIV Ped Workshop 2011) 13 38
S Africa (Moodley D AIDS 2009) 3
KZN S Africa (Moodley D JID 2011) 34 (25100wy)
KZN S Africa (Chetty Moodley JCV 2012)
13
Zimbabwe (Munjoma MW BMC Pub Hlth 2010 Nov 310668 57100wy
Kenya (Kinuthia J Curr HIV Res 2010 Oct8(7)510-4 26 (68100wy)
Malawi (Keating MA Plos One 2012) 1 (4100py)
HIV Incidence Rates During Pregnancy and Postdelivery
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Continued Exposure to HIV During Pregnancy and Postdelivery
bull Pregnancy is not protective against sexual transmission of HIV- irrespective of being being married or being monogamous ndash Sexual Activity
ndash Condom Use
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Sexual Activity among Women during Pregnancy and Postpartumndash South Africa
(n=2835)
0
200
400
600
800
1000
1200
1400
A B C DA gt ONCE PER WEEK B ONCETWICE PER MONTH C ONCE IN 6 MONTHS D CURRENTLY ABSTAINING
37 43
2
17
Moodley D et al Incident HIV Infection in Pregnant and Lactating Women and its Effect on Mother to Child Transmission in South Africa J Infect Dis 2011 May 1203(9)1231-4 Epub 2011 Mar 11
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Keating M et al High HIV Incidence and Sexual Behavior Change among Pregnant Women in Lilongwe Malawi Implications for the Risk of HIV Acquisition PLoS One 2012 7(6) e39109
Sexual Activity during early pregnancy late pregnancy postpartum and non-pregnant
study groups ndash Malawi (n=1087)
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
4008
8811
45065203
0
10
20
30
40
50
60
70
80
90
Resumed SexualActivityInconsistent CondomUse
14w 14w 9m 9m
High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention The SAHAPS Study (South Africa)
Stankard Maman Moodley et al High sexual risk behavior among postpartum women in urban South Africa implications for HIV prevention IAS 2012
POSTPARTUM
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
MTCT ndash SCV during PregnancyLabour Delivery Study Country N Infected MTCT
Nuttall et al 5 - Rudin et al Switzerland 24 50
Hague et al UK 59 56
Nielsen-Saines et al Brazil 39 33 Moodley D et al South Africa 839
(83925) 205 (vs 9)
Lu LS 3rd HIV Ped Workshop 2011 Botswana 275377 73
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
MTCT ndash SCV during Breastfeeding Study Country N Infected MTCT
Colebunders DRC 13 33
Palasanthiran Australia 311 27
Hira Zambia 319 16
Van der Perre Rwanda 815 53
Embree Kenya 512 42
Liang China 38106 36
Lu L 3rd HIV Ped Workshop 2011)
Botswana 3971103 36
Humphrey Zimbabwe 334 24
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
HIV IN PREGNANCY ndash VIRAL LOAD WOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL
1999
05
1015202530354045
lt1000 1000-10000
10000-50000
50000-100000
gt100000
HIV Viral Load (copiesml)
MTC
T (
)
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
HIV DURING LABOUR AND DELIVERY ndash VIRAL LOAD SHAFFER ET AL JID (1999)
0 10 20 30 40 50
Maternal HIV RNA at Delivery (copiesml)
M
TCT
()
lt6573 6573- 13177
13178- 33759
33760- 93126 gt93126
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
HIV IN BREASTMILK ndash VIRAL LOAD Rousseau et al JID 2003 187
0
10
20
30
40
50
60
70
80
lt100 101-1000 1001-10000 gt10000
Perin
atal
HIV
Infe
ctio
ns
Inci
denc
e10
0 pe
rson
-yea
rs
Viral load (copiesml)
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Humphrey J H et al BMJ 2010341bmjc6580
HIV Seroconversion and Breastfeeding Transmission
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Maintaining high plasma HIV-1 RNA load after acute infection
bull The proportion of extended high viremics was 34 [95 confidence interval (CI) 23ndash44] during the period 100ndash300 days ps
bull The median (IQR) duration of HIV-1 RNA load at least 100 000 copiesml among extended high viremics was 271 (188ndash340) days ps
bull Estimated that Early HIV index cases are responsible for 19-52 of HIV transmissions in Lilongwe Results suggest that the initial period of elevated transmissibility may be fairly long (~5 months) and that transmissibility during EHI is 30 times as great as during Chronic HIV
Novitsky Vladimira et al Extended high viremics a substantial fraction of individuals maintain high plasma viral RNA levels after acute HIV-1 subtype C infection AIDS 31 July 2011 - Volume 25 - Issue 12 ndash p 1515ndash1522
Kimberly A Powers et al The Role of Acute and Early HIV Infection in the Spread of HIV-1 in Lilongwe Malawi Implications for ldquoTest and Treatrdquo and Other Transmission Prevention Strategies Lancet 2011 July 16 378(9787) 256ndash268
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Early Diagnosis of HIV Infection in Women
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Repeat Antibody Testing bull Strategies to detect seroconversion during pregnancy are well established
and cost-effective A second anti-HIV during the third trimester along with rapid testing in labor to untested late presenters is an approach to detect late seroconversion (after the 2nd test)
MMWR Recomm Rep 2006 Sep 2255(RR-14)1-17 quiz CE1-4 Revised recommendations for HIV testing of adults adolescents and pregnant women in health-care settingsBranson BM Handsfield HH Lampe MA Janssen RS Taylor AW Lyss SB Clark JE Centers for Disease Control and Prevention (CDC)
ldquoRepeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant womenrdquo
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
POC Tests for Early Diagnosis
bull Sensitivities for early HIV infection ndash 3rd generation 55ndash57 ndash 4th generation 76ndash88
Patel et al Rapid HIV screening Missed opportunities for HIV diagnosis and prevention J Clin Virol Volume 54 Issue 1 May 2012 Pages 42ndash47
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Detecting Acute HIV Infections Pooled NAAT Testing
Citation Antenatal HIV Prevalence
N (NAAT+) HIV - tested
Incidence of Acute HIV
Median Viral Load copiesml
Malawi Gay et al 2010 Diagn Microbiol Infect Dis
302 52321 021 1324766
South Africa Kharsany et al 2010 HIV Med
373 4467 09 386260 (64200
-1228130)
Pooling is an established strategy for a timely diagnosis of HIV acute infection in seronegative serodiscordant patients
Pilcher 2002 Pilcher 2005 Fiscus 2007
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Cost Implications for Pooled NAAT Testing
bull South Africa (Kharsany HIV Med 2010)
ndash 4 of 467 tested RNA positive
ndash Cost of identifying a single case of AHI was $1313
bull US (Pilcher JAMA 2002) ndash 5 of 8155 tested RNA positive ndash the cost of identifying a single case of AHI was
$4109
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
The UN Four-Pronged Strategy for PMTCT
bullPrevention of HIV in young people
bullPrevention of HIV infection in women of childbearing age (including their partners)
bullPrevention of unintended pregnancies in HIV-positive women
bullPrevention of HIV transmission from an HIV-positive woman to her infant
I II III IV bullCare amp support for the mother and her family
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
Preventing and Managing Incident HIV
Infections During Pregnancy and Breastfeeding
ART-PrEP If HIV Uninfected
amp At Risk
HCT amp
Risk Reduction Counselling
Early ART Treatment
If HIV Infected MALE
PARTNER
MMC If HIV
Uninfected
Repeat HIV Test
amp Risk Reduction
Counselling
Treatment Of
STIs
WOMAN
ART-PrEP If HIV Uninfected
amp At Risk
CC Male
Condom Use
CC Female
Condom Use
MICROBICIDE (CAP004)
Early ART Treatment
If HIV Infected
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
UNAIDS Global AIDS Response
bull Target 3 Eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS related maternal deaths
ndash Percentage of HIV-positive pregnant women who receive antiretrovirals to reduce the risk of mother-to-child transmission
ndash Percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth
ndash Mother-to-child transmission of HIV (modelled) ndash Percentage of women who are retested for HIV during
pregnancy and breastfeeding ndash Percentage of women who seroconvert during pregnancy and
breastfeeding
Global AIDS Response progress reporting monitoring the 2011 political declaration on HIVAIDS guidelines on construction of core indicators 2012 reporting
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-
THANK YOU
- Incident HIV Infection in PregnancyBreastfeeding ndash Prevention Management
- Definitions
- UNAIDS Global AIDS Response Target 3
- Dianummer 4
- Prevention of MTCT in the US
- Dianummer 6
- Several Other Studies
- Dianummer 8
- Distribution of ART regimens for PMTCT 22 Priority Countries (2004-2010)
- What are we missing
- Dianummer 11
- Continued Exposure to HIVDuring Pregnancy and Postdelivery
- Sexual Activity among Women during Pregnancy and Postpartumndash South Africa (n=2835)
- Dianummer 14
- Dianummer 15
- MTCT ndash SCV during PregnancyLabour Delivery
- MTCT ndash SCV during Breastfeeding
- Dianummer 18
- HIV IN PREGNANCY ndash VIRAL LOADWOMEN AND INFANTS TRANSMISSION STUDY (WITS) GARCIA ET AL 1999
- HIV DURING LABOUR AND DELIVERY ndash VIRAL LOADSHAFFER ET AL JID (1999)
- HIV IN BREASTMILK ndash VIRAL LOADRousseau et al JID 2003 187
- HIV Seroconversion and Breastfeeding Transmission
- Maintaining high plasma HIV-1 RNA load after acute infection
- Dianummer 24
- Repeat Antibody Testing
- Dianummer 26
- POC Tests for Early Diagnosis
- Detecting Acute HIV InfectionsPooled NAAT Testing
- Cost Implications for Pooled NAAT Testing
- Dianummer 30
- Preventing and Managing Incident HIV Infections During Pregnancy and Breastfeeding
- UNAIDS Global AIDS Response
- THANK YOU
-