Kaiser Daily HIV/AIDS Report Summarizes Recently Released Studies on Cotrimoxazole Prophylaxis, Millennium Development Goals

• "Reduction in Preterm Delivery and Neonatal Mortality After the Introduction of Antenatal Cotrimoxazole Prophylaxis Among HIV-Infected Women With Low CD4 Cell Counts," Journal of Infectious Diseases: Jan Walter of Columbia University's Mailman School of Public Health and colleagues enrolled into the study 1,435 HIV-positive pregnant women at two clinics in Lusaka, Zambia, between April 2001 and September 2004 to determine whether antenatal contrimoxazole prophylaxis -- one of the first effective antiretroviral drugs offered to HIV-positive adults and children in the U.S. and Europe -- begun during pregnancy would affect birth outcomes. The study found that after the drug was introduced as a routine component of antenatal care, the percentage of preterm births among 255 women with CD4+ T cell counts less than 200 decreased by about 49%, neonatal mortality significantly decreased and birth weight increased. However, the researchers found no significant changes in the same parameters among HIV-positive pregnant women with CD4+ T cell counts of 200 or greater during the same time period. According to the researchers, the "data suggest that, in addition to the expected benefits for maternal health, there may be neonatal benefits from providing cotrimoxazole prophylaxis to immunosuppressed HIV-infected women during pregnancy" (Walter et al., Journal of Infectious Diseases, 12/1). Heather Watts and Lynne Mofenson of NIH in an accompanying editorial commentary said the results are "exciting, because an intervention known to be of benefit for maternal health appears to benefit infant outcomes as well" (Watts/Mofenson, Journal of Infectious Diseases, 12/1).
  

• "Putting it Together: AIDS and the Millennium Development Goals," PLoS Medicine: Robert Hecht of the International AIDS Vaccine Initiative and colleagues examined how HIV/AIDS creates obstacles to achieving several of the Millennium Development Goals beyond the immediate target of reducing the HIV/AIDS pandemic. The researchers focused on the pandemic's effect on the goals of eliminating poverty, delivering universal education, reducing child mortality, boosting maternal health and fighting malaria and tuberculosis. According to the researchers, "Governments, donors and civil society need to increase funds for HIV prevention research and product development and build political support, especially for the deeper involvement of developing countries." They conclude that MDGs can help "assess progress and motivate political support, yet the goal of global development should be not just for 2015 but also for the entire 21st century" (Hecht et al., PLoS Medicine, November 2006).