What Works for Women and Girls

for their own disease” (ITPC, 2009: 11). The 900 new cases of HIV in babies in developingcountries every day could be prevented (ITPC, 2009). 4 “…Each new pediatric HIV infection isconsidered a missed opportunity for prevention” (Abrams, 2007: 705).Providers Should Consult the Most Recent Guidelines Regarding Medications’ Effectin PregnancyCurrently, there is no evidence of a significant increased risk of birth defects associatedwith the appropriate antiretroviral treatment before conception or during the first trimester(Antiretroviral Pregnancy Registry Steering Committee, 2007 cited in Coll et al., 2008).Concerns remain about the use of efavirenz during the first trimester, however, (Panel onAntiretroviral Guidelines for Adults and Adolescents, 2009) and health care providers shouldevaluate the most recent evidence when considering its use. A review of treatment optionsfound that prophylaxis with co-trimoxazole is still advisable for persons with CD4 countsunder 200, even if they are on HAART. Experts advise that once viral load is undetectable,co-trimoxazole is no longer required. While co-trimoxazole is potentially teratogenic, WHOrecommends its use throughout pregnancy because the risk of life-threatening infectionamong women with low CD4 counts or symptomatic HIV infection may outweigh other risks(Watts and Mofenson, 2006). However, co-trimoxazole “should not be used as a substitute forthe availability of HAART regimens for pregnant women with advanced disease but rather asan adjunct” (Watts and Mofenson, 2006: 1480). Health care providers should also check themost up-to-date literature on nevirapine resistance when using nevirapine for PMTCT (Panelon Antiretroviral Guidelines for Adults and Adolescents, 2009).Nevirapine Resistance Is a Concern in Future Treatment OptionsThe WHO states “if a woman receives AZT during pregnancy, daily nevirapine is recommendedfor her child from birth until the end of the breastfeeding period” (WHO, 2009b).While nevirapine may increase the numbers of infants withHIV-free survival, treatment with nevirapine may prejudicefuture treatment for the HIV-positive infant (Lockmanet al., 2007; Coffie et al., 2008). For women who havereceived nevirapine already for PMTCT, and then accessHAART, there are some concerns that prior use of nevirapinemay hinder treatment. A study with 114 women inthe U.S. found resistance rates of up to 43% in women whohad pregnancy-limited antiretroviral treatment (Paredeset al., 2010). A study of 872 women in Zambia found thatHAART was less effective among women who had beenexposed to single dose nevirapine (Kuhn et al., 2009b).As of November 2009, the WHO no longer recommendssingle dose nevirapine for pregnant women living with HIV“At least if they had put me onART I could take care of my babyup to the second year and be sureby the time I die the baby wouldbe able to at least live with otherseasily. I have tried to talk to [thedoctors] but till now I haven’tstarted the medicine.”—HIV-positive woman in aPMTCT program in Malawi(Bwirire et al., 2008: 1197)4 Note: UNAIDS statistics for 2009 are even higher—about 1,178 per day (UNAIDS, 2009d).WHAT WORKS FOR WOMEN AND GIRLS233