‘Monumental’ HIV/AIDS Study in Botswana Will Use Two-Pronged Approach to Preventing Vertical Transmission

Researchers in Botswana and the United States are teaming up to conduct a "monumental" research project aimed at preventing the vertical transmission of HIV to newborns in Botswana, a country in which almost 50% of women may be HIV-positive, the Globe and Mail reports. The research project, named Moshi after the Setswana word for milk, will be a collaborative effort between Harvard University researchers and hospital officials in Mochudi, Botswana. Researchers will employ two distinct techniques to prevent mother-to-child transmission of HIV, one aimed at reducing transmission before and during birth, and another targeting transmission through breast milk. The first program will supplement the AZT that HIV-positive pregnant women already receive through Botswana's national program with a second antiretroviral drug, nevirapine. Because AZT alone can reduce vertical transmission of HIV by 50% to 80%, researchers hope that by adding nevirapine, which can also reduce transmission by up to 50%, they can "eliminate in utero and delivery [HIV] infections in newborns." The combined cost of the two-drug regimen will be less than $45 per person. The second part of the study will examine data to address the controversial "dilemma" of whether or not HIV-positive mothers should be encouraged to feed their babies formula or breast milk. Even with government-subsidized infant formula, an HIV-positive woman's decision about whether to breastfeed is not a "clear-cut choice," Botswana-Harvard AIDS Partnership researcher Carolyn Wester said. Breastfeeding, which is the "cultural norm" in Botswana, is responsible for approximately one-third of mother-to-child transmissions of HIV, but it also provides newborns with antibodies that boost their immune systems and protect them from numerous other life-threatening diseases. The researchers will give the breastfed newborns of HIV-positive mothers a "daily syrup containing AZT" and will compare the rate of HIV infection in those newborns to that of formula-fed infants born to HIV-positive mothers. More than 80% of Botswana's HIV-positive pregnant women have already signed up to participate in the research study (Globe and Mail, 12/8).