I had the privilege of attending several sessions of the 10th annual Namibia HIV Clinicians’ Society Congress at Ongwediva from the 12th to 14th September. As a volunteer member of the Central Committee of the Society, I attended in my capacity as the Communications/Advocacy person for this association of medical professionals, most of whom work in the private sector. The purpose of this year’s congress was to give medical professionals a taste of the 2013 International AIDS Society Conference held in Malaysia, where a number of recent development in the science surrounding HIV and AIDS came to the fore.
Dr Mugala Mukungu, a founding member of the Namibia HIV Clinicians’ Society and well known physician presented on the changes to the WHO guidelines for HIV antiretroviral therapy. As you may know, antiretrovirals form the cornerstone of biomedical interventions against HIV. Specifically, it by taking combinations of different types of antiretrovirals that HIV – known as Highly Active Antiretroviral Therapy (HAART) – that HIV patients avoid becoming AIDS patients.
Now, people can live with HIV without it ever leading to the debilitating disease, in essence being HIV positive becomes no different than being positive for the rhesus blood group.
Every so often, the WHO publishes new guidelines for the use of HAART in places like Namibia where the epidemic of HIV is so pervasive that is know as generalised, given that more than one out of every twenty people is HIV positive.
It would be germane to discuss the guidelines concerning the prevention of the transmission of HIV from mother to child (PMTCT – another acronym). The column ‘40 something and HIV/AIDS’ in The Namibian newspaper lifestyle segment The Weekender dated Friday the 13th September has prompted to write a brief summary of these guidelines. In that column, the author, a forty-something year old woman, reflects with she describes as ‘shock and horror’ on the fact that children are still born with HIV today in Namibia. The columnist bemoans the existence of stigma for children living with HIV and also questions why any woman living with HIV should ever transmit to her child. What I found fascinating was that this columnist referred to antiretroviral nevirapine as the miracle drug, which is given to a mother for PMTCT, in building her argument for why no child should be born with HIV.
Well, first of all, I would like to say that I learnt children are technically not born with HIV. That is to say, HIV infection from mother to child is not something that takes place while the foetus is still in the womb, but rather during delivery when the infant comes in contact with the mother’s blood. For this reason, when the PMTCT program first started mothers would receive nevirapine hours before delivery, to essential block the ability of HIV to propagate itself in the mothers blood and infect the baby. That was back in the early 2000s and the efficacy left much to be desired, as the reduction in transmission of HIV was just about half what it was without nevirapine. Now in 2013 the WHO no longer recommends the use of single dose nevirapine. The current recommendation is a whole simpler, without having to give the mother a specific medication that she will take just for her delivery. Now, the recommendation is that all women who are pregnant and test positive for HIV start HAART and continue for the rest of their lives.
The beauty of HAART for all pregnant women is that the concentration of HIV-1 in their blood – their viral load – falls to levels below detection with conventional laboratory equipment. If they can maintain this viral load at such a low or ‘suppressed’ level at the time of delivery, the risk of transmitting the virus to their child is negligible. And since they will continue HAART for the rest of their lives, the risk of transmitting HIV via other routes such as breast milk is also negligible.
So I believe the columnist of ‘40 something and HIV/AIDS’ should actually let all women know that if they are HIV positive and plan to have a child, they are eligible to start HAART – a combination of usually three antiretrovirals that will nearly obviate the risk of transmission to their child and prolong their own lives for an average of 50 years, given all other things equal with an HIV negative woman in a developed country.