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European research yields guidelines for treatment of HIV-positive pregnant women and infants

June 28, 2002

New guidelines for the treatment of HIV-positive women and children are emerging from European research. The guidelines, aimed at reducing mother-to-child transmission of HIV, are to be published on 28 June 2002 as a supplement to the journal AIDS. A comparable set of guidelines for paediatric patients will be published in July 2002. Both reports result from concerted action projects funded by the European Commission's DG Research.

"The definition of HIV treatment guidelines that will limit the risk of mother-to-child transmission of the virus is a good example of the benefits of collaborating at European scale", said European Commissioner for Research Philippe Busquin. "HIV knows no borders and we need to bring together the best specialists to stem the epidemic and find appropriate treatments."

In Western Europe, 560,000 people are living with HIV/AIDS. The number of HIV infected adults continues to increase: 30,000 were infected in 2001 and 25% of those are women. The occurrence of HIV-positive pregnant women is a growing concern and mother-to-child transmission (MTCT) is a critical issue.

Although potent and effective anti-retroviral therapy is now available to delay progression of the disease, this needs to be used carefully and appropriately. Fifteen research teams from seven European countries have worked together to define a set of guidelines for best practice. Their report highlights that certain precautions and the appropriate use of anti-retroviral therapy during pregnancy, labour and in the neonatal period can reduce the risk of MTCT from 15-20% (without intervention) to less than 2%.

The guidelines include:

- recommending that all pregnant women (and if possible their partners) have a HIV test;

- offering HIV-infected women the option of delivering their child through a caesarean section (before labour and rupture of membranes), as this has been shown to reduce risk of MTCT;

- offering all HIV-infected women anti-retroviral therapy during pregnancy to reduce MTCT, with choice of therapy and timing depending on their clinical status; in fact a great deal of attention is given to the various factors influencing this choice, the possibilities for treatment and the need for informed consent of the patient;

- recommending anti-retroviral therapy for the child immediately after birth;

- strongly advising HIV-infected mothers against breastfeeding, as the risk of MTCT through breastfeeding is substantial and unnecessary as safe alternatives are available.

This valuable work was co-ordinated by Prof. Marie-Louise Newell, co-ordinator of the European Collaborative Study on HIV infection in women and children, University College London (m.newell@ich.ucl.ac.uk). The other experts and contributors are listed in the annex. The full report is available in AIDS (2002) supplement 2, June, 24 pages (http://www.aidsonline.com/).

The European Commission is strongly committed to combating AIDS in Europe, through the priority on "combating major diseases" defined in the next European research Framework programme (2002-2006). It is also tackling AIDS in Developing Countries, where it is intricately linked with poverty, through the recently initiated European-Developing Countries Clinical Trials Partnership (EDCTP) which proposes to contribute EUR200 million and trigger collaboration between European and African countries.

European Commission, Research Directorate