NAM feedback from AIDS 2016 Gareth Tudor-Williams Imperial College Healthcare NHS Trust St. Mary ’ s Hospital & Imperial College LONDON, UK

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Presentation transcript:

NAM feedback from AIDS 2016 Gareth Tudor-Williams Imperial College Healthcare NHS Trust St. Mary ’ s Hospital & Imperial College LONDON, UK

8th International Workshop on HIV Pediatrics th July 2016 Durban, S. Africa

99% Prevention of vertical transmission targets (Prof Mugyeni) Pregnant mothers identified and Rx EID Early infant diagnosis Infected children on Rx

Malawi 2011: Option B+ Start HAART for any women identified as HIV+ in pregnancy and continue for life Simplifies PMTCT programme requirements - no need for CD4 testing or need to stop ART after pregnancy Extended protection to prevent vertical transmission in future pregnancies Protection from sexual transmission to partners Benefit to woman’s health More costly in short-term, but likely cost-effective over time

AIDS 2016: Option B+ Chewe Luo (UNICEF) plenary By 2015, 21 of the 22 target LMIC had adopted Option B+ S. Africa was relatively late to adopt the strategy but has rolled this out very effectively Which country in SSA has not yet got it’s act together?....

October 2015 report

Antepartum Labor/ Postpartum Maternal Health ( 14 wks-term) Delivery (for duration of BF) (after BF cessation) Infant NVP Prophylaxis Triple ARV Prophylaxis RandomizeRandomize Continue Triple ARV Regimen Stop All ARVs Mother RandomizeRandomize Infant uninfected at birth ZDV ZDV + sdNVP+ TRV Triple ARV Prophylaxis Triple ARV Prophylaxis RandomizeRandomize (Version 2.0) Maternal CD4 >350 The PROMISE trial – 3 randomisations ENROLLED 3,529 WOMEN 11/4/ DSMB stopped Antepartum Component for efficacy

Antepartum Labor/ Postpartum Maternal Health ( 14 wks-term) Delivery (for duration of BF) (after BF cessation) Infant NVP Prophylaxis Triple ARV Prophylaxis RandomizeRandomize Continue Triple ARV Regimen Stop All ARVs Mother RandomizeRandomize Infant uninfected at birth ZDV ZDV + sdNVP+ TRV Triple ARV Prophylaxis Triple ARV Prophylaxis RandomizeRandomize (Version 2.0) Maternal CD4 >350 The PROMISE trial – AIDS 2016 ENROLLED 3,529 WOMEN Taha et al: 0.6% transmission at 12 m regardless of arm

Breast feeding controversies

EID

Adolescents

TUSS06 – New evidence: why do young women in Africa have higher rates of HIV infection? T de Oliviera phylogenetic mapping: 1,500 viruses sequenced. Included an infant whose mother was HIV uninfected. Checked family members: incredibly tightly linked virus found in one of the aunts. Turned out she had breast fed the baby when mum went back to work. Proof that the methodology was working.

T de Oliviera 202 linked clusters identified possible to identify one partner monogamous partnership, and clusters of eg 5 males and 11 women. Knew ages ad sex of individuals from whom samples were obtained. Enabled linkage analysis to show that girls aged were linked to men on average 11 years older than them.

Adam Burgener / Nichole Klatt Biological factors affecting PrEP: ? role of vaginal microbial dysbiosis in vitro experiments confirmed that gardnerella could reduce TDF concentration in supernatant by 70% over 24 hours compared with lactobacilli Mechanism still being assessed