Thursday, April 12, 2007

Three article summaries, as promised

HIV prevalence in India in 2005 (image from article #2 below)

Here are the article summaries I promised a few days back. (Citations and links in pre-Easter entry.) For those more interested in pulpy personal depictions over numbing number-laden journal jargon, scroll down and have a peek at previous posts. -Ry

Article #1:
"Increasing Antiviral Drug Access for Children with HIV Infection
Committee on Pediatric AIDS, Section on International Child Health"

Background: Aproximately 540,000 under fifteen year-olds were infected wth HIV in 2006. A total of 2 million infected kids live in SS Africa, and ~660,000 needed ARVs immediately according to a study done in 2005. [Comment: so much for “immediately”.] Without treatment, about a third die by one year of age and half by two years of age.

Barriers: Though there has been progress in preventing and treating pediatric HIV in resource-rich countries, scaling up in resource-limited areas remains wrought with challenges, including:
· lack of appropriate testing technology for diagnosis, especially in young infants
· lack of health care worker training in pediatric HIV prevention, care and treatment
· lack of availability of ARV formulations that are easy to use and inexpensive (read: cheap pills in smaller sizes needed to replace liquid meds)

The article goes on to make sixteen policy recommendations as to how to address these “lacks”. I can send them to you if you’d like.

[Comment: Examples of our ongoing responses to these challenges are as follows: dried blood spot PCR for early infant diagnosis, HCW training programs (like the one cited below in “quote 7 of 10”), and transitioning to pill-cutting instead of liquid formulation.]

Article #2:
"HIV in India-A complex epidemic"
India has a population of 1.1 billion, a sixth of the world’s population. About one of every eight HIV infected people live there. There are 5.7 million HIV-infected in India, by some estimates more than in SS Africa. While the prevalence is much lower in India (~1% among 15-39yos) compared to Africa (mean = ~20%), the “sheer numbers” serve as a wake-up call. Though the economy is modernizing, India’s slums and vast rural population (70% of total) are home to underweight children (>half of under three year-olds), illiterate women (~50% nationwide), and many other realities that invite the virus to spread—gender inequality (only half of wives report that they “usually participate in household decisions”), spousal violence (37.2% of married women report it), commercial sex work (up to 2 million workers nationwide), and “bridge populations” (i.e. truckers and migrant workers). India, while “populous and complex,” has “substantial resources” and a “record of accomplishment” in addressing other epidemics, and a multifaceted approach to HIV is both possible and imperitive.

[Note: Pardon the brevity and crudeness of this summary; please see complete article for more.]

Article #3:
“Mother-to-child transmission of HIV-1 during exclusive breastfeeding on the first 6 months of life: an intervention cohort study.”

[Note: This one sounds technical but it’s bottom line is important. Many young babies, regardless of HIV status, die of malnutrition in SS Africa. Do read on.]

Background: Exclusive BF, though good for child survival, is rare. This study examines HIV-1 transmission and survival associated with various infant feeding practices.

Methods: 2722 women (HIV+ and neg) were followed while feeding infants, HIV testing was done periodically, and transmission risks were calculated at 6 weeks and 22 weeks of age.

Findings and interpretation, in brief: Mortality in exclusively breastfed infants (median BF 159 days) was lower than those given replacement feeds (6.1 vs 15.1%), and infants receiving solid foods or formula while breastfeeding were significantly more likely to acquire HIV. Infant feeding guidelines need to be adjusted to better support exclusive breastfeeding in HIV positive women with exposed infants.


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