What Works for Women and Girls

own health needs has never been evaluated. The new WHO guidelines represent the currentconsensus on best international practice for the use of ARVs in pregnant women in developingcountry settings for both the maintenance of the woman’s own health and the preventionof mother-to-child transmission of HIV (WHO, 2009b). Development of these guidelinesproceeded according to the WHO GRADE procedure and included costing analyses of thedifferent options under review (WHO, 2009b). Of course, many important questions remainunder consideration, including the long-term effects on the health of women who initiate ARVtherapy as prophylaxis to prevent mother-to-child transmission and then stop treatment (Panelon Antiretroviral Guidelines for Adults and Adolescents, 2009). A study funded by NIH thatstarted in January 2010 with results expected in 2015 should answer this vital question. ThePROMISE Study (Promoting Maternal-Infant Survival Everywhere) is a multi-national clinicaltrial in 18 countries that is being conducted by the International Maternal Pediatric AdolescentAIDS Clinical Trials Group. It will examine the long-term effects on the health of women whoinitiate ARV therapy as prophylaxis to prevent vertical transmission and then stop treatmentin addition to comparing the effectiveness of different drug combinations for the treatment ofPMTCT (NIAID Web Bulletin, January 21, 2010).WHO recommends pregnant women who access HAART with CD4 counts above 350(i.e., for PMTCT prophylaxis) should continue “through the end of the breastfeeding period”(WHO, 2009b: 14); implying that women can stop HAART at the end of breastfeeding if theirCD4 count remains above 350. Until the results from the PROMISE study are available, thequestion about what this might mean for the woman’s future treatment options remains.Treatment Regimens for Preventing Vertical Transmission Vary GloballyIt should be noted that the development of ARV regimens to treat pregnant women and preventvertical transmission is evolving and implementation varies around the world. For instance,in Europe, the initiation of ARV therapy in pregnant women proceeds according to the sameCD4 count measurements as are used to initiate therapy within the general population, withthe goal of full suppression of HIV by the third trimester of pregnancy (European AIDSClinical Society, 2009). By contrast, in the United States, ARV therapy is now recommendedfor all pregnant women, regardless of their CD4 counts (Panel on Antiretroviral Guidelines forAdults and Adolescents, 2009).It is important to note that the evidence base in this section does not yet reflect implementationof the November 2009 WHO guidelines. At the time of this writing, the final WHOguidelines, slated for publication in June 2010, remain pending (WHO, 2009b). The evidencepresented in this section should thus be considered in light of the new WHO guidelines andpending research in the field.WHAT WORKS FOR WOMEN AND GIRLS235