Bringing AZT to poor countries

A magic bullet for the “African” mother? Neo-Imperial reproductive futurism and the pharmaceutical “solution” to the HIV/AIDS Crisis

On the basis of a close reading of popular and medical texts which address a debate over the ethics of clinical drug trials funded by the United States and designed mainly for sub-Saharan Africa, I argue that international public health discourse about infant HIV infection in that region reflects and legitimates a neo-imperialist, anti-reproductive justice ideology. Participants share a fetal-centered logic that US-funded biomedicine must shoulder the burden of rescuing sub-Saharan Africa from itself by using the bodies of HIV-positive pregnant women to transmit biomedicine's magic bullet—antiretroviral drugs—to the next generation. The survival of the fetus, disguised as the well-being of the HIV-positive woman and accomplished by the magic of biomedical research, becomes the survival of a region otherwise doomed by its present state of economic, political, and medical incapacity. This version of what queer theorist Lee Edelman (2004, No Future: Queer Theory and the Death Drive) calls “reproductive futurism” redounds to the benefit of the more explicitly women-hating and nationalist ideologies of still-powerful right-wing movements against reproductive and sexual rights.

The inter-relation of maternal immune competence, HIV-1 viral load, and nutritional status in preventing vertical transmission: an alternative to chemoprophylaxis?

As the human immunodeficiency virus (HIV) global pandemic moves towards the end of its second decade, women of reproductive age throughout the world have been shown to be increasingly at risk for acquiring HIV-1 infection. Recently, the focus for preventive measures has expanded to include preventing the perinatal transmission of HIV-1 to fetuses and newborns. This manuscript reviews the available literature that examines risk factors for perinatal transmission, immunopathogenesis of HIV-1 infection, and the role that antioxidant micronutrients play in modulating immune response to HIV-1 disease progression. The available information provides a compelling case for the design of studies that evaluate the extent to which maternal HIV-1 viremia and disease progression are modulated by her nutritional status. Should results from these studies confirm that antioxidant micronutrient status is inversely related to HIV-1 RNA load, particularly in economically vulnerable populations, carefully designed and executed supplementation trials would be warranted.

The future of prenatal HIV testing

The use of zidovudine for the prevention of mother-to-child transmission of human immunodeficiency virus, as well as continuing advances in our understanding of the determinants of that transmission, and of potential new avenues of intervention augur ever more efficient perinatal prevention strategies in the near future. In this paper the evolving role of prenatal testing in an era of ever more successful interventions will be discussed. At least four factors will be critical in determining what that role will be: clinical, legal, ethical and economic. Each of these are parochial, i.e. they will feature in eradication strategies in different ways in different geographical, economic and cultural settings. An understanding of these factors will help to suggest what course testing policy should take and to determine the role clinicians must play if any testing policy is to succeed in contributing to the end of pediatric HIV disease.

Late postnatal mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire

BACKGROUND

HIV-1 can be transmitted from an infected mother to her infant through breastfeeding, although the precise risk of transmission by this route is unknown. A long-term follow-up of children born to HIV-infected women in Abidjan, Côte d'Ivoire, has enabled us to estimate this risk.

METHODS

Children born to 138 HIV-1-seropositive women, 132 HIV-2-seropositive women, 69 women seroreactive to both HIV-1 and HIV-2, and 274 HIV-seronegative women were enrolled at birth and followed up for as long as 48 months. All children were breastfed (median duration 20 months). Blood samples for either or both HIV PCR and HIV serology were obtained at 1, 2, and 3 months of age, and every 3 months thereafter. Early HIV infection was defined as a positive HIV-1 PCR result obtained in the first 6 months of life. Late postnatal transmission was diagnosed when a child had a negative PCR at 3 or 6 months of age, followed by either or both a positive HIV-1 PCR at 9 months or older, or persistently positive HIV-1 serology at 15 months or older.

FINDINGS

82 children born to HIV-1-seropositive mothers and 57 children born to mothers seropositive for both HIV-1 and HIV-2 had PCR results for samples taken within the first 6 months. By 6 months of age, 23 (28%; 95% CI 19-39) of the 82 children born to HIV-1-seropositive mothers and ten (18%; 95% CI 9-30) of the 57 children born to dually seropositive mothers were HIV-1 infected. Among children whose PCR results were negative at or before age 6 months, and who were followed up beyond 6 months, an additional four (9%) of the 45 children born to HIV-1-seropositive mothers and two (5%) of the 39 children born to dually seropositive mothers became HIV infected. The estimated rates of late postnatal transmission, with account taken of loss to follow-up and the observed pattern of weaning, were 12% (95% CI 3-23) and 6% (0-14), respectively. One of the five children whose mothers seroconverted from HIV-negative to HIV-1, and one of seven children whose mothers seroconverted from HIV-2 to dual reactivity, became HIV-1 positive. No case of late postnatal transmission occurred in children born to HIV-2-positive or persistently HIV-negative mothers.

INTERPRETATION

Breastfed children born to mothers seropositive for HIV-1 alone or seropositive for HIV-1 and HIV-2 in Abidjan are at substantial risk of late postnatal transmission. Early cessation of breastfeeding at 6 months of age should be assessed as a possible intervention to reduce postnatal transmission of HIV.