Cape Town - Dr Olive Shisana, principal researcher on the national HIV survey that was released by the Human Sciences Research Council in April, has highlighted prevention of mother-to-child transmission (PMTCT) as one of the fronts on which the country is winning in the complicated war against HIV and Aids.
“Some media reports on the SA National HIV Prevalence, Incidence and Behaviour Survey, 2012, stated that South Africa is losing the war on HIV infection,” she says. “The report, however, concluded that the war on HIV and Aids has many fronts and South Africa is winning on a number of these.”
She singled out the country’s PMTCT programme, which has seen a sharp decline in new infections among infants. Professor Salim S Abdool Karim, president of the Medical Research Council, says that more than 98 percent of women now receive an HIV test during pregnancy and that almost 92 percent of HIV-positive mothers are receiving antiretroviral (ARV) treatment or prophylaxis.
He says that “community level impact” was now evident from all South African PMTCT programmes and that, “within 10 years of initiating the country’s first PMTCT programme, 95 percent of all health facilities were providing this service by 2010. South Africa is also one of four countries that have achieved more than 80 percent coverage of antiretroviral prophylaxis for PMTCT.”
According to the World Health Organisation (WHO), “in the absence of any interventions, transmission rates from mother to child range from 15 percent to 45 percent” but that, with effective interventions, “this rate can be reduced to levels below 5 percent”.
South Africa’s efforts have fallen within the goals of the global community which, according to the WHO, “committed itself to accelerate progress for prevention of mother-to-child HIV transmission with the goal to eliminate new paediatric HIV infections by 2015 and improve maternal, newborn and child survival and health in the context of HIV”.
Children sector representative on the South African National Aids Council, Professor Ashraf Coovadia, says, “This success has been in large part due to improvements in antiretroviral drug choices available and the widespread accessibility to the PMTCT programme.”
And, he adds, “Women are now able to receive highly effective treatment as soon as they enter the programme at any clinic throughout the country.”
Another milestone over the past few years has been the switch to “breast is best” as a government campaign.
Says Coovadia, “Breast-feeding was initially discouraged as it was another route of HIV transmission. The government committed itself to providing formula, but due to high costs and distribution problems this, in itself, led to additional and more serious problems.”
It became evident that formula-feeding introduced high risks of conditions like malnutrition, diarrhoea, and in many cases, related deaths, and the policy was then reviewed.
“Breast-feeding is now encouraged as antiretroviral drugs will assist with prevention of HIV transmission and the baby will receive all the well-known benefits of breast milk,” says Coovadia.
Liezel Pienaar, a research pharmacist at the Empilweni Services and Research Unit in Johannesburg, says, “It is now felt that the country has reached a point where almost complete eradication of a paediatric HIV is a reality.”
She says the country’s programme links to the Millennium Development Goals which were defined by a declaration by the UN in 2000.
“By having a good policy in place, we see fewer babies being born HIV-positive. This is a significant contributor to the reduction in child mortality.”
However, the best and most obvious method of preventing HIV in newborn babies is by preventing it in adults.
Says Shisana, “South Africa needs to develop targeted prevention efforts among key populations”.
She made specific reference to high-risk groups which included black women from age 20 to 34, people living together but not married who are aged 15 to 49, and black men from 25 to 49.
Sea may provide weapon in war on Aids
In the search for prophylaxes against the spread of HIV, few might have thought to look among the coral reefs for the answer.
But, just three days ago, a group of American researchers said that coral reefs could provide potent new anti-HIV proteins.
The new class of proteins, discovered by the researchers from the American Society for Biochemistry and Molecular Biology, is capable of blocking HIV from penetrating T-cells. This has raised hopes that the protein could be adapted for use in gels or sexual lubricants to provide a barrier against HIV infection.
“It’s always thrilling when you find a brand new protein that nobody else has ever seen before,” says senior investigator Barry O’Keefe, “and the fact that this protein appears to block HIV infection – and to do it in a completely new way – makes this truly exciting.”
The researchers, who have screened thousands of natural products, zeroed in on the proteins, called cnidarins which were found in a feathery coral collected in waters off Australia’s northern coast.
The research team identified and purified the proteins, then tested their activity against laboratory strains of HIV. They proved to be highly potent, capable of blocking HIV at concentrations of a billionth of a gram. They did this by preventing the first step in HIV transmission, in which the virus must enter a type of immune cell known as theT-cell.
The next step is to refine methods for generating the proteins in larger quantities.
“Making more of it is a big key,” said O’Keefe. “You can’t strip the earth of this coral trying to harvest this protein, so our focus is on finding ways to produce more of it so we can proceed with preclinical testing.”
Cape Times