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III. Antiretroviral Treatment

A. MTCT-Plus Program:  In 2005 CAI launched a new diagnosis and treatment initiative to prevent Mother To Child Transmission (MTCT) while simultaneously providing antiretroviral therapy for the mother (the “+” in MTCT-Plus.)  CAI and the Chinese Academy of Medical Science’s AIDS Research Center worked with Columbia University’s MTCT-Plus team to bring this model of care and treatment to China.  In April 2005 the program was piloted in Hubei province, with a team of trainers from Columbia, Yale, and ADARC in collaboration with Wuhan University and Hubei health authorities. The trainees were physicians, gynecologists, obstetricians, nurses, counselors, and lab workers from each of the four highest-prevalence counties.

CAI is expanding this model to other central provinces and to Yunnan, and exploring ways to bring it to Xinjiang. The Yunnan CDC will test 100,000 pregnant women over the next 12 months, with the expectation more than 400 will test positive. The goal is to rapidly implement and disseminate the protocol that provides both treatment for the mother and prophylaxis for the baby, systematic application of which could decrease MTCT from 30% to below 2%.

B. Antiviral Regimen Trials:  ADARC is also working closely with CAMS to conduct studies that have established the ARC as one of the leading clinical research institutes in China working on HIV and AIDS. To date ARC has conducted seven clinical trials of antiretroviral regimens, with ADARC providing technical input. Recent research is focused on defining the drug resistant profiles in Chinese patients.

C. Molecular Epidemiology Studies: ADARC and CAMS have also collaborated on several molecular epidemiology studies, in cooperation with Yunnan CDC, Wuhan University, and Henan Bureau of Health. It is clear from these studies that multiple subtypes of HIV and genotypes of Hepatitis C virus have already been introduced into China, primarily from bordering countries.  Since 1994, China has experienced exponential increase in the number of infected individuals but also an expansion in the complexity of virus genotypes. Multiple recombinant forms between various subtypes have also been identified. Increasing prevalence of multiple subtypes will raise the possibility of inter-subtype recombination in the future, posing further difficulties for future treatment and vaccine studies.