Open Access Highly Accessed Commentary

Asking the right questions: developing evidence-based strategies for treating HIV in women and children

Quarraisha Abdool Karim12, Anchilla Banegura3, Pedro Cahn4, Celia DC Christie5, Robert Dintruff6, Manuel Distel7, Catherine Hankins8, Nicholas Hellmann9, Elly Katabira10, Sandra Lehrman11, Julio Montaner12, Scott Purdon13, James F Rooney14, Robin Wood15 and Shirin Heidari16*

Author Affiliations

1 Department of Epidemiology, Columbia University, New York, USA

2 Prevention and Epidemiology, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa

3 Global Virology Access, Tibotec Pharmaceuticals Ltd, Nairobi, Kenya

4 Direccion Cientifica, Fundacion Huesped, Buenos Aires, Argentina

5 Department of Pediatrics, University of the West Indies, Kingston, Jamaica

6 Commercial Development, Abbott, Abbott Park, Illinois, USA

7 Medical Affairs, Boehringer Ingelheim GmbH, Ingelheim, Germany

8 Office of the Deputy Executive Director, UNAIDS, Geneva, Switzerland

9 Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA

10 Department of Research, Makerere Medical School, Kampala, Uganda

11 Scientific Affairs - Infectious Diseases, Office of the Chief Medical Officer, Merck & Co, Upper Gwynedd, Pennsylvania, USA

12 AIDS Research and Head of Division of AIDS, University of British Columbia, Vancouver, Canada

13 Access and Government Affairs, ViiV Healthcare, Middlesex, UK

14 Medical Affairs, Gilead Sciences, Foster City, California, USA

15 Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Centre, University of Cape Town, South Africa

16 Research Promotion, International AIDS Society, Geneva, Switzerland

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BMC Public Health 2011, 11:388  doi:10.1186/1471-2458-11-388

Published: 25 May 2011

Abstract

In July 2010, the World Health Organization (WHO) issued formal revisions of its guidelines on the use of highly active antiretroviral therapy for HIV. The new guidelines greatly expand eligibility for treatment of adults and children, as well as for pregnant women seeking prophylaxis for vertical HIV transmission. WHO's new recommendations bring the guidelines closer to practices in developed countries, and its shift to earlier treatment alone will increase the number of treatment-eligible people by 50% or more.

Scaling up access to HIV treatment is revealing important gaps in our understanding of how best to provide for all those in need. This knowledge gap is especially significant in developing countries, where women and children comprise a majority of those living with HIV infection. Given the magnitude and significance of these populations, the International AIDS Society, through its Industry Liaison Forum, prioritized HIV treatment and prophylaxis of women and children. In March 2010, the International AIDS Society and 15 partners launched a Consensus Statement outlining priority areas in which a relative lack of knowledge impedes delivery of optimal prevention of mother to child transmission (PMTCT) and treatment to women and children.

The Consensus Statement, "Asking the Right Questions: Advancing an HIV Research Agenda for Women and Children", makes a special appeal for a more gender-sensitive approach to HIV research at all stages, from conception to design and implementation. It particularly emphasizes research to enhance the understanding of sex-based differences and paediatric needs in treatment uptake and response. In addition to clinical issues, the statement focuses on programmatic research that facilitates access and adherence to antiretroviral regimens. Better coordination of HIV management with sexual and reproductive healthcare delivery is one such approach.

We discuss here our knowledge gaps concerning effective, safe PMTCT and treatment for women and children in light of the expansion envisioned by WHO's revised guidelines. The guideline's new goals present an opportunity for advancing the women and children's agenda outlined in the Consensus Statement.