Dr. Avinash Shetty
- an assistant professor at pediatrics at Wake Forest University School of Medicine
- is working to reduce that possibility.Shetty is a member of a team of researchers conducting a study in Africa with a drug that can be given to mother and child.
It shows promise of not only significantly reducing the rate of HIV transmission, but also of being economically viable for use in poor countries.
A woman infected with HIV may pass on the infection to her
child in three ways.The virus could pass through the placenta during pregnancy.It could infect the child during birth when the child is exposed to the mother's blood and other bodily fluids.And the child could be infected through breast milk.
Infection by breastfeeding represents a significant risk in Zimbabwe, where Shetty
and the others have been conducting their study.Breast-feeding is estimated to be responsible for a third to a half of the HIV infections in children.
An obvious way to avoid those infections would be for the mother not to breast-feed her
child.Although that's practical in the United States, it often is not in such countries as Zimbabwe.
The formula that would replace breast milk can be prohibitively expensive.
"Immediately, the rest of the community comes to know the woman is HIV positive," Shetty
Reducing the number of infections through breast-feeding could save many lives.This part of Africa has one of the highest rates of HIV infection in the world.More than 25 percent of Zimbabwe's adults are HIV-positive.Among pregnant women, the infection rate is even higher - more than 30 percent.The disease, spread there predominantly through heterosexual sex, has reduced the average life expectancy to 43 years.
"The male may desert that woman," Shetty
said."They may not have any social support.The family may disown that woman."
In looking for ways to reduce HIV infection through breast milk, the challenge facing Shetty
and other doctors and researchers is to find a method affordable in poor countries.
A course of treatment that has been effective in studies in the United States includes formula-feeding.It costs $800 to $1,000 per mother and child, which is impractical in poor countries.
Shetty's work builds on a study in Uganda in which the treatment cost is $4 per mother/child.That approach was not as effective as the more expensive treatment, which reduced transmission rates by 68 percent.But it was still effective enough to reduce transmission rates by 47 percent.
"It looks like it could be a cost-effective intervention for resource-poor settings," Shetty
This approach uses a drug called nevirapine.It has well-documented benefits in treating HIV in other contexts, and it stays active in the body for a relatively long time.In Uganda, a single dose of nevirapine was given to the mother at the onset of labor, and a single dose to the infant between 48 and 72 hours after birth.
In the first phase of the study that Shetty
is participating in, a small group was observed to make sure that the treatment was safe.It appeared to be safe.In the second phase, which is just getting under way, a larger group is participating.If further study documents the effectiveness of this approach, it could be a real boon for the region.
Shetty hopes that his
research will also help people in other parts of the world.He
grew up in India where, he
said, HIV is "blossoming" into a significant problem.
is focusing on reducing the risks of transmitting the disease through breast milk, he
is well aware of all the related issues.These include the importance of educating people about the disease, reducing the stigma, persuading people to be tested, and providing treatment for all involved.
"If you don't treat the mother or father, these kids will be orphans," he
said.Estimates are that the disease has orphaned 900,000 children in Zimbabwe, where 12 million people are infected.Of the 40 million people in the world with HIV/AIDS, 28.1 million of them are in sub-Saharan Africa. Shetty, 36, earned his medical degree in India.
A fellowship in pediatrics at the Louisiana State University School of Medicine
in New Orleans brought him to the United States.From there, he went to Stanford University School of Medicine in Palo Alto, Calif., for a fellowship in pediatric infectious diseases. Shetty
has been going to Zimbabwe for about three years.At times, he
has stayed three and four months.More recently, he
stayed for three or four weeks.He
returned from a trip there in February, and he
has another trip scheduled for May.Shetty
does much of his
work at clinics in Chitungwiza, which is near Harare, the country's capital.
The study is a joint project between Stanford University
, the University of California at San Francisco
and the University of Zimbabwe
, with sponsorship from the National Institute of Allergy and Infectious Diseases
through the HIV Prevention Trials Network of the National Institutes of Health
came to Winston-Salem last summer.He works with children at Brenner Children's Hospital, which is part of Wake Forest University Baptist Medical Center.
Some of the children he
sees are dealing with HIV.Others are dealing with other illnesses.