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New Drug Therapy To Ensure Newborns of HIV+ Women Stay Safe
Jyoti Shelar
Mumbai Mirror
January 22, 2014


Starting Feb 1, HIV-infected pregnant women will undergo a multi-drug therapy instead of the single dosage that is presently administered.

The HIV-infected pregnant women in the state will now be administered a multidrug therapy instead of a single dosage of drug to prevent transmission of infection to their babies. Starting February 1, the National Aids Control Organisation will roll out the multi-drug regimen in Mumbai and rest of Maharashtra, with an aim to achieve zero transmission rate in newborns.

All hospitals and anti-retroviral therapy (ART) centers have been informed about the new regimen, while the Mumbai District Aids Control Society (MDACS) and the Maharashtra State Aids Control Society (MSACS) are training doctors, nurses and counsellors.

"We have the stock of new medicines to last at least the next five months. We will roll out the new regimen on February 1," Dr Balakrishna Adsul, additional project director at MDACS, said.

At present, a single dosage of drug Nevirapine, an economically viable option, is in use. To prevent the transmission, the HIV-infected pregnant women are given Nevirapine tablet two hours before delivery and the newborn is given Nevirapine syrup within 72 hours of birth.

While medical experts have linked Nevirapine to drug-resistant HIV in mothers, the usage of this drug was also phased out world over as it was found to be less effective. The World Health Organisation too prescribed the multi-drug regimen but India continued to use the single dose Nevirapine due to affordability.

According to Dr Adsul, the multi-drug therapy will be started from the 14th week of pregnancy and combination of three drugs that work on two enzymes will be administered till delivery. The newborns will be given Nevirapine syrup for six consecutive weeks.

"The combination of drugs is known to reduce the viral load in the mother. With reduced viral load, the chances of transmission automatically go down," said Dr Rekha Daver, head of obstetrics and gynecology, J J Hospital, adding that it is the "most ideal drug regimen followed worldwide".

Implementing the multi-drug therapy will be challenging as most pregnant women register with hospitals very late. "If the women register early, their HIV test and other examinations can be carried out and the drug regimen can be started on time," said Sudhakar Joshi, joint director, basic services division, MDACS. He said that the community health workers and activists from various NGOs will be on the field to ensure that pregnant women are registered with hospitals within the first few weeks.

In Mumbai alone, as many as 400 HIV-positive women deliver babies annually. Experts say that in cases where infected women were not administered Nevirapine, about 40 per cent newborns tested positive for the infection.

In cases where the Nevirapine drug was administered before delivery, the infection rate dropped to 5 per cent to seven per cent. "With the multi-drug regimen, we are hoping to reduce the infection rate to barely two per cent," Dr Daver said.

CHILDREN AT RISK

HIV transmission from mother to her newborn is known to occur during all three phases: pregnancy, delivery and breastfeeding. Without any intervention this risk is known to be about 40%.

The prevention of parent-to-child (HIV) transmission (PPTCT) programme was launched under the National Aids Control Programme in 2002.

There are an estimated 2.39 million people living with HIV (PLHIV) in India, with national adult HIV prevalence of 0.31 per cent. Of these, women constitute 39 per cent of all PLHIV, while 4.4 per cent are children. As on March 2012, 99,000 HIVpositive children had been registered under the antiretroviral therapy (ART) programme.

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