Study Shows Bnabs May Be Viable Treatment For Children With Hiv
Shapiro R, et al. Abstract 32. Presented at: Conference on Retroviruses and Opportunistic Infections Feb. 12-16, 2022 .
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Broadly neutralizing monoclonal antibodies, or bNAbs, may be a viable treatment option for young children with HIV, according to study findings presented at the Conference on Retroviruses and Opportunistic Infections.
Children who received early ART may be an ideal group for treatment with bNAbs,Roger L. Shapiro, MD, MPH, an associate professor of medicine at Harvard Medical School, said while presenting the findings.
Long-term ART has adherence challenges and side effects, but a low viral reservoir and limited HIV diversity in these children may be associated with successful outcomes with bNAbs, Shapiro said.
Shapiro and colleagues evaluated the monthly IV dosing of two bNAbs VRC01LS and 10-1074 as a treatment alternative to ART among a cohort of 28 HIV-positive children in Botswana who began HIV treatment less than 7 days after birth. The children had a median age of 3.6 years upon enrollment.
Twenty-five children from the initial cohort were eligible for step two, during which ART was held and treatment with dual VRC01LS and 10-1074 was continued for up to 24 weeks, and HIV RNA was checked every 1 to 2 weeks, Shapiro explained.
Orphans And Vulnerable Children
One of the most devastating impacts of HIV is the loss of whole generations of people in communities hardest hit by the epidemic. In this regard, it is often children who feel the greatest impact via the loss of parents or older relatives.
An ‘orphan’ is defined by the United Nations as a child who has ‘lost one or both parents’. An estimated 13.4 million children and adolescents worldwide had lost one or both parents to AIDS as of 2015. More than 80% of these children live in sub-Saharan Africa.17 In some countries which are badly affected by the epidemic, a large percentage of all orphaned children for example 74% in Zimbabwe, and 63% in South Africa are orphaned due to AIDS.18
Remarkable gains have been achieved in mitigating the economic and social impact of HIV and AIDS on children and families over the past decade. Still, children orphaned by AIDS, or who are living with sick caregivers, continue to face an increased risk of physical and emotional abuse as compared with other children in sub-Saharan Africa, including other orphans. This increases these childrens vulnerability to HIV.19
HIV programmes focusing on orphans and vulnerable children are a vital strategy for reducing vulnerability to HIV in children. These programmes focus on supporting carers of children, often older generations, keeping children in school, protecting their legal and human rights, and ensuring that their emotional needs are catered for.20
If I Breastfeed Will My Baby Get Hiv
The CDC recommends that mothers living with HIV avoid breastfeeding their babies. While the risk of your baby getting HIV if you choose to breastfeed is very, very low for women with a suppressed viral load, there is still a risk. Infant formula is the best option for your baby.
The World Health Organization does recommend breastfeeding in countries with limited access to clean water, but this is under very strict guidelines.
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Knowing Is Half The Battle
In 2018, 19% of new HIV cases were in women. One in nine of these women were unaware of their HIV status. These women, who don’t know their HIV status, may be at the highest risk of passing the virus on to their children if they choose to become pregnant, particularly if they do not receive HIV testing, and treatment, as part of timely prenatal care.
If you become pregnant, it is extremely important for you to be tested for HIV as early as possible during your prenatal care. Even if your risk of exposure is minimal, it is better to be safe than sorry. Knowing your HIV status will help with your peace of mind. More importantly, however, if you are positive, the sooner you start treatment, the safer you can keep your future child.
If you are pregnant, and you don’t know your HIV status, ask your practitioner to test for HIV you as part of your prenatal care. Although all healthcare providers should be offering HIV tests to every pregnant patient, many do not. That’s unfortunate because universal testing and treatment of pregnant women could help eliminate mother to child transmission of HIV.
Reducing The Risk Of Passing Hiv To Your Baby
If you have HIV, you can reduce the risk of passing it to your baby by:
- taking antiretroviral drugs during pregnancy, even if you don’t need HIV treatment for your own health
- considering the choice between a caesarean or vaginal delivery with your doctor
- bottle feeding your baby, rather than breastfeeding
- your doctor prescribing your baby antiretroviral drugs for up to 4 weeks after they have been born
Do not breastfeed your baby if you have HIV, as the virus can be transmitted through breast milk.
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More Help And Support
- Positively UK is a charity providing support to people living with HIV and can offer you friendly peer support groups and workshops.
- Body and Soul is based in London and provide a range of support to families and children including groups for tots, children and teens.
- i-base pregnancy guide is up-to-date and exhaustive .
- If you live in London, Positive Parenting and Children might be able to help you.
- CHIVA, the Children’s HIV Association has lots of resources for parents and families affected by HIV.
How Do I Know If I Have Hiv
If you are pregnant, it is important to attend your antenatal appointments, as these are the times when you can get an HIV test.
Your healthcare professional will offer you a test at your first appointment. If the result is positive you will be encouraged to start antiretroviral treatment as soon as possible. You will also be offered a test in your third trimester .Remember that, whether you are pregnant or not, if you do have HIV you may not show any symptoms. The only way to know whether you are HIV-positive is to get tested.
If at any point during your pregnancy or breastfeeding stage you think you have been exposed to HIV, you may be able to take post-exposure prophylaxis . You need to take PEP within 72 hours of possible exposure to prevent HIV from establishing in your body and being passed on to your baby. If youre breastfeeding, you should discuss whether or not to continue breastfeeding with your healthcare professional.
If you are pregnant, it is important to attend your antenatal appointments, as this is where you can get an HIV test.
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Drug Resistance And Treatment Costs
Although the cost of initial ART for children has reduced dramatically due to the availability of generic drugs, if a child develops drug resistance and needs to begin a second line of drugs, treatment becomes far more expensive.66
In fact, HIV drug resistance to the select few medications which are palatable among children is becoming an increasing concern among health practitioners with more children developing treatment resistant strains of the virus as a result of the scale up of prevention of mother-to-child transmission programmes. For infants exposed to PMTCT programmes, the WHO has also estimated that there is a HIVDR prevalence of 21.6%, compared to just 8.3% among those with no treatment exposure.
In 2017, the results from a five-year-long study observing the efficacy of treatment in Zambia found that 40% of infants diagnosed with HIV in Lusaka had resistance to at least one ART drug by 2014 compared to 21.5% in 2009.67
Frequently Asked Questionsexpand All
You and your health care professional will discuss things you can do to reduce the risk of passing HIV to your baby. They include the following:
Take a combination of anti-HIV drugs during your pregnancy as prescribed.
Have your baby by cesarean delivery if lab tests show that your level of HIV is high.
Take anti-HIV drugs during labor and delivery as needed.
Give anti-HIV drugs to your baby after birth.
Do not breastfeed.
Treatment during pregnancy has two goals: 1) to protect your own health, and 2) to help prevent passing HIV to your fetus. Many combinations of drugs are used to manage HIV infection. This is called a “drug regimen.” Anti-HIV drugs decrease the amount of HIV in the body.
Drugs used to treat HIV infection may cause side effects. Common side effects include nausea, diarrhea, headaches, and muscle aches. Less common side effects include anemia, liver damage, and bone problems such as osteoporosis. While unusual, drugs used to treat HIV may affect the development of the fetus. However, not taking medication greatly increases the chances of passing the virus to your fetus.
Your viral load is the amount of HIV that you have in your body.
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Hiv And Planning A Family
, but for a woman who is HIV-positive, or who has a male partner with HIV, planning a family requires extra consideration.
If you are in this situation, seek professional advice and find out as much as you can before you become pregnant. It may help to talk the issues through with:
- The doctor who is treating you.
- Your HIV specialist, obstetrician or family planning specialist.
- The Chronic Viral Illness Clinic at Melbournes Royal Womens Hospital . CVI clinic staff are experienced and knowledgeable about HIV in pregnancy and can provide expert advice and assisted reproductive technology options for serodiscordant couples .
- A counsellor who specialises in this area.
Symptoms And Stages Of Hiv Infection
- There are three stages of HIV infection. The symptoms vary in type and severity from person-to-person.
- Stage 1 after initial infection can feel like flu but not everyone will experience this.
- Stage 2 is when many people start to feel better and may last for 10 years or more. During this time a person may have no symptoms.
- Stage 3 is when a persons immune system is very badly damaged and can no longer fight off serious infections and illnesses.
- The earlier a person is diagnosed with HIV and starts treatment, the better their health will be over time.
- Some people dont get any symptoms during stages 1 and 2, and may not know they have the virus, but they can still pass on HIV.
The signs of HIV infection can vary in type and severity from person-to-person, and some people may not have any symptoms for many years.
The stages below describe how HIV infection progresses in the body if it is left untreated. Without antiretroviral treatment for HIV, the virus replicates in the body and causes more and more damage to the immune system.
However with effective treatment, you can keep the virus under control and stop it from progressing. This is why its important to start treatment as soon as possible after testing positive.
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Stage : Clinical Latency
In this stage, the virus still multiplies, but at very low levels. People in this stage may not feel sick or have any symptoms. This stage is also called chronic HIV infection.
Without HIV treatment, people can stay in this stage for 10 or 15 years, but some move through this stage faster.
If you take HIV medicine every day, exactly as prescribed and get and keep an undetectable viral load, you can protect your health and have effectively no risk of transmitting HIV to your sexual partner.
But if your viral load is detectable, you can transmit HIV during this stage, even when you have no symptoms. Its important to see your health care provider regularly to get your viral load checked.
Hiv : Can I Still Have Kids If Im Hiv
One of the most common questions from those who learn they are HIV-positive is whether they can still have kids. Here’s what you need to know.
Yes, you can still have kids if you are HIV-positive. The great news is that if you have your viral load suppressed to undetectable levels you likely won’t have to do anything special, as you can no longer transmit the virus . Still, if you are planning to make a baby the old fashioned way, you should speak with a specialist first. For those whose viral load isn’t suppressed, there are specialists who deal with HIV, fertility, and insemination. If youre a woman who is positive, additional medications can also decrease your chance of perinatal transmission. If youre a man with detectable HIV, your sperm may need to be washed of HIV and then inseminated into your partner, wife, or surrogate. If you want to adopt, there are protections for HIV-positive parents-to-be that ensure you cant be discriminated against.
Can I Take Hiv Medicine During Pregnancy
HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother’s health.
If you haven’t used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:
- Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
- It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
- HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
- Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.
If you are taking HIV drugs and find out you’re pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:
How Are Hiv And Aids Treated
Medicines can help people with HIV stay healthy. They can also prevent HIV from becoming AIDS. People with HIV and AIDS usually need to take a few different medicines. The medicines must be taken exactly as prescribed or they won’t work.
- help keep the number of CD4 cells high
- lower the viral load of HIV
Regular blood tests will check to see how well the medicines are working.
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What If I Want To Get Pregnant And My Partner Has Hiv
If you are trying to get pregnant and your partner does not know whether he has HIV, he should get tested.
If your partner does have HIV and you do not, talk to your doctor about taking PrEP. PrEP stands for pre-exposure prophylaxis.This means taking medicines to prevent HIV. The PrEP helps to protect both you and your baby from HIV.
Stage : Acute Primary Infection
The early symptoms of HIV can feel like having the flu. Around one to four weeks after getting HIV, you may start to experience these flu-like symptoms. These normally dont last long . You may only get some of the symptoms and some people dont have any symptoms at all.
Symptoms can include:
- joint aches and pains
- muscle pain.
These symptoms happen because your body is reacting to the HIV virus. Cells that are infected with HIV are circulating throughout your blood system. In response, your immune system tries to attack the virus by producing HIV antibodies this process is called seroconversion. Timing varies but once you have HIV it can take your body up to a few months to go through the seroconversion process.
Having these symptoms alone does not mean you definitely have HIV. The only way to know if you have HIV is by taking a test. You should always visit your healthcare professional if youre worried about or think youve been at risk of getting HIV, even if you feel well and dont have any symptoms. They can then arrange for you to get tested.
HIV will not always show up in a test at this early stage, and you may need to test again later to confirm your result . Your healthcare professional will talk to you about the timing of your test and answer any concerns. Its important not delay speaking to a healthcare worker if you are worried about HIV.
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Advice If You’re Pregnant
HIV treatment is available to prevent you passing HIV to your child.
Without treatment, there’s a 1 in 4 chance your baby will become infected with HIV. With treatment, the risk is less than 1 in 100 .
Advances in treatment mean there’s no increased risk of passing the virus to your baby with a normal delivery.
But in some cases, a caesarean section may still be recommended, often for reasons not related to your HIV.
Discuss the risks and benefits of each delivery method with the staff at your HIV clinic. The final decision about how your baby is delivered is yours, and staff will respect that decision.
If you have HIV, do not breastfeed your baby as the virus can be transmitted through breast milk.