Urge the World Health Organization (WHO) to revise its guidelines to  recommend full-course antiretroviral treatment for all expectant and  breastfeeding mothers worldwide, in place of short-course therapy. 

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Dr. Margaret Chan, Director General
World Health Organization

Re: WHO Guidelines for the Use of HAART in HIV Infected Pregnant and Breastfeeding Women

Dear Director Chan,

We the undersigned HIV/AIDS medical care providers and advocates are concerned about the use and recommendation of short-course therapy (such as single-dose Nevirapine and/or Zidovudine) for expecting and breastfeeding mothers considered ineligible for full-course Highly Active Antiretroviral Therapy (HAART) by WHO's current guidelines. Short-course treatment has been proven to be less effective at preventing HIV transmission and less safe for both mother and child than a full HAART regimen. Therefore, we call for World Health Organization (WHO) treatment guidelines to be changed to recommend full-course antiretroviral treatment for all expecting and breastfeeding mothers worldwide.

It is universally acknowledged that the reduction – and eventual elimination – of HIV among children represents not only a moral obligation but also an important front in preventing new HIV infections. Currently, over 2 million children are infected with HIV and there are several hundred thousand children born HIV positive each year (an estimated 330,000 to 410,000 in 2007). Over 90% of these infections are a result of transmission from HIV positive mothers to their infants [2008 AIDS epidemic update. Geneva, UNAIDS/WHO, 2008]. While these troubling numbers actually represent some progress compared to previous years, it is clear that more effective and sustainable interventions are needed to meet our commitment to reduce HIV among children and deaths among mothers.

Despite this, WHO guidelines on the prevention of mother to child transmission (PMTCT) still recommend short-course therapy even though it is clinically less effective at preventing MTC transmission and more harmful than full-course antiretroviral treatment. In contrast, the use of full-course ARV therapy essentially eliminates MTC transmission, lowering the overall risk to as little as 1.2%. The largest study of MTCT rates to date found that when appropriate full-course treatment is administered, 99% of babies were born uninfected with HIV. Moreover, these findings are consistent with several other studies that found that the primary effect of HAART, a reduction in the amount of HIV virus in the body, also essentially eliminates the risk of acquiring HIV via sexual transmission.

However, changes to the clinical practices of countries using short-course therapy cannot take place without the WHO’s leadership. Most developing countries rely on WHO guidance before they change or implement any clinical policy; therefore it is imperative for the WHO to revise its treatment guidelines on this matter to help facilitate the transition from short-course therapy to full-course HAART.

Widespread implementation of this standard will dramatically reduce the number of children born with HIV, reduce the number of women at risk for developing resistance to standard first-line treatments and will have a tremendous economic impact in lower income countries as the number of people requiring higher-priced second-line treatments will also be reduced. Implemented worldwide, the health outcomes of thousands of women would be vastly improved and the lives of thousands of children could be saved.

We look forward to the WHO’s leadership and action on this matter.

Sincerely,

Michael Weinstein, President
AIDS Healthcare Foundation

Homayoon Khanlou, MD, Chief of Medicine USA
AIDS Healthcare Foundation

Robert R. Redfield, Jr., MD, Professor/Chief of Infectious Diseases
Director of the HIV program
University of Maryland, School of Medicine

Jane Aronson, MD, CEO/Founder
Worldwide Orphans Foundation

Sophia Mengistu, MD, Country Director/Ethiopia
Worldwide Orphans Foundation

Rodney L. Wright, MD, MS, Assistant Professor/Director of HIV Programs
Albert Einstein College of Medicine

Martina C. Fuchs, MD, PhD, CEO
Real Medicine Foundation

Julio Montaner, MD

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