Antiretroviral Tharepy (Essay Sample)

DOES ANTIRETROVIRAL THERAPY PREVENT THE TRANSMISSION OF HIV TYPE-1 FROM INFECTED MOTHERS TO THEIR INFANTS DURING BREASTFEEDING IN SUB-SAHARA AFRICA
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Submission Date: 15th January 2013
Introduction (800words)
HIV (the Human Immunodeficiency virus) is a retrovirus, which attacks the human immune system by gradually destroying it and thereby impairing its normal function, making the infected person prone to infections (Pratt, 2003). After what can be up to 10-15 years of being HIV infected, the infection may develop into the disease or syndrome called AIDS (WHO, 2010). An HIV positive person is said to have the disease AIDS (Acquired Immunodeficiency Syndrome) if the cells, which protect the body from disease (CD4+ T Cells) indicate a count of 200 or less (CDC, 2008).
HIV and AIDS are a serious public health challenge worldwide, with statistics indicating an approximated 34 million people to be living with AIDS worldwide (WHO, 2010). An estimated 23 million of these are accounted for by the sub-Saharan African (SSA) region (UNAIDS Report, 2011). The AIDS epidemic is therefore clearly seen to be even more of a health challenge in this particular region of the world, especially among women of the reproductive age between 15 and 44 years of age (De Cock et al, 2000).
Being in the prime of their reproductive years, this would imply that these HIV infected women once pregnant, would hold the risk of transmitting the HIV virus onto their infants. Mother-to-child transmission (MTCT) of HIV is the largest known source of the HIV infection in children up to the age of 15 years (UNAIDS, 1999). According to UNAIDS (2010) more than 1500 children become infected by HIV worldwide every day. 90% of these children acquire it through their mothers. Mofenson (2008) and De Cock, et al (2000) further add that 90% of these children are accounted for by the sub-Saharan region of Africa.
In order to achieve maximum effective prevention results of mother-to-child transmission (MTCT) of HIV infection, it is primarily important to understand the different modes through which this virus can be transmitted. MTCT can occur inside the womb during pregnancy, labour or delivery, mainly during any blood contact (De Cock et al, 2000). Despite MTCT, being preventable at this stage through strategies such as caesarean section delivery before labour begins, unfortunately, MTCT can still occur after the birth of an infant through breastfeeding, which is the main focus of this assignment. De Cock et al (2000) estimate in a review of research carried out in resource-limited areas, where prolonged breastfeeding is common, that without intervention 5% MTCT occurs inside the womb, 15% during delivery and 15% during breastfeeding, suggesting that the overall rate of MTCT in the area is 35%. WHO (2009) confirms this by reporting that without the use of interventions, the risk of HIV transmission is 35% in a breastfeeding population, whereas it is only 25% in a non- breastfeeding population.
In a systematic review by Bond et al (2007), it is also concluded that the majority of children living with HIV acquire it through their mothers. This collective evidence therefore suggests that the prevention of mother-to-child transmission would be a significant step in the reduction of paediatric HIV infections.
This academic assignment will focus specifically on the breastfeeding aspect of HIV transmission. It is a critical literature review based on a set of carefully selected journal articles (Thior et al, 2006; Kilewo et al, 2008; Kesho Bora study group, 2010 and Campbell et al (2012) on the use of antiretroviral therapy (ART) to prevent MTCT through breast-feeding. This assignment focuses uniquely on the sub-Saharan region of Africa (SSA).
The rationale for this particular choice of health challenge topic is a deep passion for the fight against HIV especially in children, who are the future generation. This interest arises as a result of the personal loss of family members to AIDS. Furthermore, the choice to focus on the sub-Saharan geographical region was because it is the worst affected by the HIV infection, as well as my place of origin.
Antiretroviral (ARV) drugs, Antiretroviral therapy (ART) and Breastfeeding
Antiretroviral drugs do not cure HIV and AIDS, but enable HIV infected people to live longer and healthier lives (Unknown Author. 2010). ARVs make this possible by suppressing the replication of the HIV virus, and thus reducing its negative effect on the infected body’s immunity (Pratt, 2003).
ART can be defined as the “treatment of people infected with human immunodeficiency virus (HIV) using anti-HIV drugs”, whose pattern of treatment consists of a combination of at least three drugs in order to reduce the virus’ possibility to develop resistance (WHO, 2012). These drugs suppress the replication of HIV and therefore have the potential to improve the quality of life of infected people while reducing infection and death rates (WHO, 2012; Pratt, 2003). In the light of this assignment, the latter is the concept applied in the attempt to prevent HIV transmission from an infected mother to her child.
Aim (50words):
This assignment aims to demonstrate whether or not ARV therapy prevents the transmission of HIV type-1 from infected mothers to their HIV negative infants during breastfeeding, and if so, to what extent. This will be achieved through a critical exploration of the methodology and findings of a number of carefully selected recent articles, identified by a comprehensive literature search. This will also give an insight into the most appropriate infant feeding practice for HIV-1 infected mothers in poor sub-Saharan African household.
Literature Search (400words):
The first research article selected for critical review was identified during an initial online Google search on information available on MTCT (Kilewo et al., 2008).
The rest of the articles and literature were acquired through online databases under Star plus through the Sheffield University library access. These databases were Cochrane, CINHAL (Cumulative Index to Nursing and Allied Health Literature) and MEDLINE (Medical Literature Online).
For the purpose of some background, reading the Cochrane database of systematic reviews was searched first via the Cochrane library (Volmink et al., 2007). The Keywords or phrases used to search under this database were “Antiretroviral therapy”, “mother to child transmission” and “breastfeeding”. This search yielded 3 results out of 7530 records (Siegfried et al, 2011; Sturt et al., 2010; and Tudor Car et al., 2011) the latter two were used to acquire basic knowledge on the selected topic, being the most recent. Siegfried et al (2011) was however eliminated because of research that is more recent and the conclusions of this review had since been changed.
The CINHAL database was searched using the key words ‘’HIV or AIDS’’ which gave 64,188 results; “Antiretroviral” gave 5,511; “Breastfeeding” gave 6,034; Africa” gave 14,885bresults; “Sub-Sahara Africa” gave 8 results; while “Mother to child transmission’’ gave 523. These key word results were then combined eventually giving 40 results from which 29 pieces of literature were relevant to the subject and further read for more information on the topic.
Critical Literature Review (2000words):
The efficacy of ART is therefore critically reviewed in this assignment. This was done by analysing research work, which has been carried out in the recent years to demonstrate the same (Kesho Bora Study Group, 2010; The Mitra Study/ Kilewo et al, 2008; The Mashi Study/ Thior et al, 2006 ; Shapiro et al, 2010 and Campbell et al, 2012)-
The following section is a critical literature review of relevant articles. However, in order to focus specifically on the aspects of the research papers which point towards the answer of this assignment’s question, three themes were derived from the articles, and the research process involved was further critically analysed. These selected themes were CD4+ Count and ART; Efficacy of ART in breastfeeding and the Safety/ Danger of Breastfeeding as a feeding strategy for infants with HIV infected mothers.
1st THEME- Efficacy of ART during breastfeeding (650 words):
Exclusive breastfeeding for infants up to the age of 6 months is highly recommended because of the significant nutritional benefit breastfeeding provides to the infants, as well as the health benefits it brings to the breastfeeding mother (UNICEF, 2010). As mentioned earlier however, breastfeeding is one of the modes of MTCT of HIV from infected mothers to their uninfected infants. What may therefore seem logical at this point would be to avoid breastfeeding all together. Research however shows, that this could have adverse effects on the infant’s health in resource- limited areas such as sub-Sahara Africa, leading to high infant mortality rates as a result of subsequent disease conditions like diarrhoea and malnutrition (Thior et al, 2006; UNICEF & UNAIDS, 2010).
Infant’s chances of HIV-free survival
The entire clinical importance of this research question was to establish whether the combination of ART and breastfeeding actually improves the chances of an infant surviving without contracting the HIV infection.
According to Thior et al (2006) children breast-feeding from mothers who were under ART recorded a high probability of not contracting HIV. However, this relied on how well the HIV positive mothers were able to avoid predisposing factors such as injuries on their breast and whether they were consistent in administering ART. Mothers who were not keen in the use of the ART ended up infecting their chil...