With a Scalpel and some Patience

24. June 2008

A recently published PLoS - study shows: The HIV rapid test by saliva sample shortly before delivery can reduce the transfer risk for the newborn considerably - because faster results enable an on-time decision for a C-section. Mainly in countries were HIV screening is not part of the routine, further expansion of the disease could be averted.

It is a day like any other day in a normal country hospital in India: Conventional HIV tests are made from venous blood samples, the results take days. For physicians it is a debacle. Because every hour they lose in a case with a detected HIV infection of the mother might mean a shorter life span for the baby. A rapid test by saliva sample takes only 20 minutes and provides more exact results than the researchers initially expected. 1,200 women were tested with the new procedure, 15 patients turned out to be HIV positive. Although the initial results of the saliva test showed only 14 positive cases, the subsequent new interpretation finally brought about the last correct diagnosis.
From a molecular diagnostic point of view a full success. Because the results of the blood- and the saliva test correspond 100%. Consequences are just as simple as effective: Immediate measures such as a C-section or a preventive antiretroviral therapy can be taken, if the physician knows about the HIV infection of a para or breast feeding mother. Western nations achieved a decrease of the infection rate under two percent. The rate in developing countries is clearly higher – which is not just due to a lack of therapy options. The simple but shocking reason: The nescience of the majority of the mothers regarding their infection.

Everything is at stake

Every day more than 1000 children get infected with HIV worldwide. According to UNICEF about 2.5 million boys and girls total are suffering from HIV. You might want to interpret those figures like this: Condoms alone do not do it in the third world – because hardly anyone is using them.

In the light of such dimensions professionals bank on a new strategy: The direct cooperation with affected countries and fresh money for innovative prevention measures are supposed to stop the rapid spreading of the virus. The odds are in our favour. Last November, the Bundesministerium für Bildung und Forschung (BMBF, federal ministry of education and research in Germany) announced its support of the European initiative EDCTP (European and Developing Countries Clinical Trials Partnership) meant to expedite clinical studies for development of drugs and vaccines against Aids as well as tuberkulosis and malaria. One of the essential targets, as the ministry emphasizes, is “the strengthening of sciences in Africa”.

This is not about image cultivation, but about the future of the children concerned – and that means – everything is at stake. All in all, the program EDCTP Investition budgets 600 million Euro originating share and share alike from the EU commission, the participating states and addition public and private funds. But different from before, it is no longer about new vaccines or wonder pills – the program is destined to research better options for treatment of Aids in developing countries.

Microbiocides against HIV

To stop the spread of epidemic is also a concern of the European Union. The search for “a safe and effective microbiocide to prevent the HIV transfer in women” is worth a subvention of 4.2 million Euro by the EU. The physicians hope that the vaginally applied substances could “decrease HIV transfer by sexual intercourse”. Microbiocides can be used as gels, cream, film, suppository or sponge or even as a vaginal ring releasing the active ingredient gradually. And they are mainly for application in Africa.

Because there are 74 percent of the HIV infected young adults in the age group 15 to 24 females. According to a report published by UNAIDS in November 2006, today more women in the age of 15 and older are infected with the HIV than ever. Until 2009 the 4.2 million Euro will continue flowing. Eight clinical test sites in Kenya, Ruanda, South Africa and Zimbabwe are supposed to leverage this new strategy. On the other hand the Institute for Tropical Medicine in Belgium performs trainings in Africa in the field of clinical tests. Prevention – that’s the message – can save lives – but this time it is about establishing of clinical preventive measures. Thus the diagnostic successes in India put a completely different complexion on things: The rapid test can prove advantageous for the African hospitals as well.

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