Blood bonds

Results will be released a year later, but this Rs 2-crore study funded by the National Institutes of Health, US, that has partners in B J Medical College (BJMC) Pune, National AIDS Research Institute, KEM hospital, Mumbai and The Johns Hopkins School of Medicine, Baltimore, US, shows promise.

‘‘Since 2002, our study has enrolled over 700 women and infants to test the effects of nevirapine (NVP-popular anti-retroviral drug) treatment on mother to child HIV transmission. What’s more an approximate 70,000 expectant mothers have been provided with access to counselling for care during pregnancy,’’ says Dr Gowri Sastry, project coordinator of prevention of HIV transmission from Mother to Infant (MIT) study.

Let’s take a look at the numbers—According to WHO around 2.2 million women living with HIV/AIDS give birth each year. India is home to the world’s largest HIV population-over 5 million people infected—the percentage of HIV cases that are attributed to perinatal transmission is increasing every year in India.

According to National AIDS Control Organisation, in 2004 the total number of infants infected with HIV through perinatal transmission was more than 1.3 lakh. So can we prevent this HIV transmission via breast milk?

THERE are several modes of transmission of HIV during the pre, peri and post-natal stages. In the post-natal stage the transmission occurs through breast milk. Hence international guidelines recommend formula feeding for mothers living with HIV. ‘‘ But this is not possible in a country like India,’’ says Dr V N Karandikar, Chairman Community Advisory Board of the MIT project and Director of Health Sciences, Bharati Vidyapeeth Medical College. Formula feeding is not economically feasible nor is it culturally acceptable, he explains. Also recent studies have shown that non-breastfed infants have a much higher risk of mortality from pneumonia, sepsis and diarrhea than from HIV. So breast-feeding still appears a safe choice worldwide for many mothers including HIV-positive ones.

What this ambitious research project aims at is determining a feasible and effective way of preventing mother to infant (vertical) transmission of HIV via breast milk, says Dr Mrudula Phadke, principal investigator of the project in India and also Vice-Chancellor of Maharashtra University of Health Sciences, Nashik. The other principal investigator is Dr R C Bollinger, Professor of Infectious Disease Division, The Johns Hopkins School of Medicine, Baltimore, US.

MOTHERS and infants enrolled in the study were divided into two groups—one control and the other experimental. In groups, mothers and infants received a dose of NVP during childbirth to prevent HIV transmission in the birth canal during the pre-natal stage.

In addition to these six weeks, both groups of infants received multi-vitamin supplements (MVI) and were given untreated breast milk by their mothers. In the experimental group, however, infants were also placed on a six-week regimen of NVP.

Phadke emphasises on breastfeeding and points out that initial results showed that there were higher rates of hospitalisation for infants of HIV positive mothers who were not breastfed than those who were exclusively breastfed. While the results of the study are eagerly awaited, there have been several successful side projects that sprouted from the original idea, says Sastry.

The study has enrolled over 700 breastfeeding woman and infants. And yes, the infant death rate—born to HIV positive mothers is less than the death rate for urban Maharashtra— that is 44 per 1000 (study) vs 57 per 1000 (India) vs 45 per 1000 for urban and rural Maharashtra.

The project has created awareness about HIV in the rural areas, about 500 nurses have been trained and certified for care of HIV patients at Sassoon government hospital and provided post-exposure prophylaxis (PEP) programme to 200 health care workers who needed emergency treatment.

That’s not all. The infrastructure development at Sassoon hospital includes high speed internet connectivity, advanced medical and videoconferencing equipment and yes, the government staff is a better trained and sensitive one to handle HIV cases and counsel pregnant women.

• According to the WHO, about 2.2 million women living with HIV/AIDS across the world give birth each year

• In 2004, the total number of infants infected with HIV through perinatal transmission was more than 1.3 lakh, says the the National AIDS Control Organisation