As part of the next step of the AIDS Care Programme in the Ukraine, HIV positive babies in an MSF project are to be treated with an antiretroviral therapy. The main focus of the project in the southern part of the Ukraine is the prevention of HIV transmission from mother to child.

Preliminary monitoring data shows that, with a single dose of nevirapine to the mother during labour, and a single dose of nevirapine to the baby just after birth, it is possible to reduce the rate of HIV transmission from 25-30% to 8-15%.

This means that, with a simple intervention, MSF is preventing transmission, by up to 50%, of the babies that would otherwise become infected with the HIV virus. Some of the babies who are born with the infection very quickly develop full-blown AIDS.

These 'fast progressors' develop fungal and respiratory infections that are typical of AIDS. The first step in addressing these issues was the provision of prophylactic cotrimoxazole, which has significantly reduced the number of respiratory infections with a simple, daily dose of a very inexpensive medication.

For the next step of a comprehensive approach to care, MSF will start to provide triple-therapy antiretrovirals to those infants who face a triple stigma: at least one of their parents has HIV; often one of their parents is an IV drug use; and the infants themselves are infected with HIV. Although it will be important to ensure that laboratory facilities are upgraded for the careful monitoring of efficacy and toxicity, babies are much more easily monitored than adults. If their growth rate is normal, the therapy is working. If they stop growing, the treatment is ineffective.

As a further expansion of the programme, the team in the Ukraine is investigating if and how it will be feasible to provide antiretroviral therapy to HIV positive mothers who develop signs and symptoms of AIDS.