As increasing numbers of women and children are infected with HIV in the evolving global epidemic, NICHD research continues to test and refine effective interventions to slow HIV progression in women, reduce mother-to-child transmission, and to treat infants who do not escape the infection. New findings from NICHD research should enable developing countries with differing health policies and resources to achieve, within their financial and logistical capacities, longer, healthier lives for women with HIV and lower rates of HIV transmission from mothers to infants. Other new findings will enable clinicians to better understand the comparative safety and efficacy of different multi-drug treatments for infants with HIV and when to start the treatments.

Multi-vitamins during pregnancy and after birth delay progression of HIV in women. At a time when Tanzania was unable to provide anti-HIV drugs to most of its pregnant women with HIV, researchers were able to use high doses of vitamins B, C, and E, during pregnancy and for five years after birth, to slow significantly the progression of HIV in women without access to drug therapies.[1] These findings are from the first large-scale, placebo-controlled trial of multi-vitamin therapy in pregnant women with HIV for whom standard drug therapies were unavailable. The researchers also found significantly higher levels of infection-fighting cells and lower levels of the HIV virus in women who took the multi-vitamin supplements, compared with those in the study's control group who did not receive the supplements. The findings indicate that the vitamins strengthened the women's immune systems and reduced the rate at which the HIV virus replicated itself. While giving vitamin supplements during or after pregnancy - regardless of HIV status -- is routine in developed countries, this is not generally the case in the developing world. The low cost of the vitamin regimen could enable more countries with limited resources to keep women with HIV healthier, longer, while directing antiretroviral drugs to women in advanced stages of the infection.

Starting anti-HIV drug therapy early in HIV-infected infants is well tolerated and highly effective in reducing viral replication. HIV infection progresses more rapidly in children than in adults, but few studies address the best time to begin anti-HIV drug therapy in HIV-infected infants. Researchers recently reported that starting multi-drug anti-HIV therapies in infants with HIV at age three months or younger significantly suppressed HIV virus replication in the children for up to four years.[2] This effect was less strong in children who were older than three months when they began drug therapy. In a relatively small clinical trial comparing three- and four-drug therapies, the researchers found that the infants tolerated each drug combination well, with relatively few side effects. The four-drug combination of stavudine, lamivudine, nevirapine, and nelfinavir was associated most strongly with long-term viral suppression. Just as importantly, however, the study's data highlighted the best time to start treating infants and demonstrated that combination therapies are safe and effective enough to warrant larger, randomized trials to determine the best drug combination. Researchers caution that ultimately, early antiretroviral treatment must be coupled with a vaccine that would stimulate and maintain immune responses, if long-term treatment of HIV-infected children is to succeed.