Rates of mother-to-child transmission of HIV-1 in Africa, America and Europe : results from 13 perinatal studies

The goal of this exercise was to provide estimates of the mother-to-child transmission rate (TR) of human immunodeficiency virus type 1 (HIV-1), calculated according to standardized methods. Prospective cohort studies in Africa, the Caribbean, Europe, and the USA observed from birth children born to women known to be HIV infected at the time of delivery. TRs were calculated and compared by investigators during a meeting in Ghent (Belgium) in September 1993 according to agreed methodology. TRs were calculated following the direct and the indirect methods developed in 1992 by the Ghent Working Group. The direct method uses a classification of children born to HIV-seropositive mothers according to their probable HIV infection status at 15 months of age or before, if they die or are lost to follow-up. Minimum, intermediate, and maximum estimates of TR are computed depending on how children classified as indeterminate are counted. The indirect method is applied for studies with a comparison cohort of children born to HIV-seronegative mothers. TRs in developed countries ranged from 14 to 25% with the direct method (intermediate estimate). In the developing world, they ranged from 13 to 42% with the direct method, from 21 to 43% with the indirect method, and most of the studies reported a TR in the range of 25 to 30%. With use of a standardized methodology, the overall TR of HIV-1 tends to be higher in Africa than in Europe or the USA. The variation in TRs is probably due to differences in factors associated with increased risk of transmission. This is of importance for the design and implementation of trials evaluating interventions aimed at reducing mother-to-child transmission of HIV. (Résumé d'auteur

The Spectrum projection package: improvements in estimating mortality, ART needs, PMTCT impact and uncertainty bounds

BACKGROUND: The approach to national and global estimates of HIV/AIDS used by UNAIDS starts with estimates of adult HIV prevalence prepared from surveillance data using either the Estimation and Projection Package (EPP) or the Workbook. Time trends of prevalence are transferred to Spectrum to estimate the consequences of the HIV/AIDS epidemic, including the number of people living with HIV, new infections, AIDS deaths, AIDS orphans, treatment needs and the impact of treatment on survival. METHODS: The UNAIDS Reference Group on Estimates, Modelling and Projections regularly reviews new data and information needs and recommends updates to the methodology and assumptions used in Spectrum. The latest update to Spectrum was used in the 2007 round of global estimates. RESULTS: Several new features have been added to Spectrum in the past two years. The structure of the population was reorganised to track populations by HIV status and treatment status. Mortality estimates were improved by the adoption of new approaches to estimating non-AIDS mortality by single age, and the use of new information on survival with HIV in non-treated cohorts and on the survival of patients on antiretroviral treatment (ART). A more detailed treatment of mother-to-child transmission of HIV now provides more prophylaxis and infant feeding options. New procedures were implemented to estimate the uncertainty around each of the key outputs. CONCLUSIONS: The latest update to the Spectrum program is intended to incorporate the latest research findings and provide new outputs needed by national and international planners

HIV ascertainment through repeat home-based testing in the context of a treatment as prevention trial (ANRS 12249 TasP) in rural South Africa

International audienceBackgroundThe ANRS 12249 TasP cluster-randomised trial evaluates whether HIV testing of all members of a community, followed by immediate antiretroviral treatment (ART) for infected people, will prevent onward sexual transmission and reduce HIV incidence at population level. Ascertaining the HIV status of a high proportion of the population regularly and repeatedly is key to the success of any universal test and treat strategy, as the first step of the HIV cascade.MethodsBetween March 2012 and March 2014, we implemented three six-monthly rounds of home-based HIV counselling and testing in ten local communities (clusters). At each home visit, individual questionnaires were administered and a rapid HIV test offered to all trial participants. We report early results on rates of HIV ascertainment, defined as undergoing a rapid HIV test or HIV-positive self-report.ResultsOf 12,911 eligible individuals (resident in the trial area and ≥16 years), 10,007 were successfully contacted at least once. At first contact, HIV status was ascertained for 7,628 (76.2% [95% CI: 75.4-77.1]) individuals. At second contact, among the 5,885 individuals contacted a second time, HIV status was ascertained for 2,829 (85.0% [95% CI: 83.7-86.2]) of the 3,328 tested negative at first contact and for 543 (45.7% [95% CI: 42.9-48.6]) of the 1,188 who refused a rapid test at first contact. Overall, HIV ascertainment rate was 89.0% (5,239/5,885 [95% CI: 88.2-89.8]) among trial participants contacted twice.ConclusionsRepeat home-based HIV testing is acceptable and feasible in this rural area. Socio-demographic characteristics, behaviours, attitudes, household characteristics and experience of HIV infection and ART in the household will be explored for their association with HIV ascertainment uptake. This will inform whether this intervention reaches the individuals at higher risk in a rural South African region

ORAL LESIONS OF HIV-INFECTED CHILDREN IN WEST AFRICA IN THE ERA OF ANTIRETROVIRAL TREATMENTS

Oral Communication presented at the "Forum des Jeunes Chercheurs", Brest (France) 2011

Temporal trend of the first prescription of nevirapine: the ANRS CO3 Aquitaine Cohort, 1997-2008

International audiencen.