Comparisons of antiretroviral regimens in pregnancy and breast- feeding

January 01, 0001

Comparisons of antiretroviral regimens in pregnancy and breast- feeding

These investigators from Botswana and the US randomly assigned 560 HIV-1-infected pregnant women (CD4+ count, 200 cells per cubic millimeter) to receive coformulated abacavir, zidovudine, and lamivudine (the nucleoside reverse-transcriptase inhibitor {NRTI} group) or lopinavir-ritonavir plus zidovudine-lamivudine (the protease-inhibitor group) from 26 to 34 weeks' gestation through planned weaning by 6 months post partum. A total of 170 women with CD4+ counts of less than 200 cells per cubic millimeter received nevirapine plus zidovudine-lamivudine (the observational group). Infants received single-dose nevirapine and 4 weeks of zidovudine.

They found: "The rate of virologic suppression to less than 400 copies per milliliter was high and did not differ significantly among the three groups at delivery (96% in the NRTI group, 93% in the protease-inhibitor group, and 94% in the observational group) or throughout the breast-feeding period (92% in the NRTI group, 93% in the protease-inhibitor group, and 95% in the observational group). By 6 months of age, 8 of 709 live-born infants (1.1%) were infected: 6 were infected in utero (4 in the NRTI group, 1 in the protease-inhibitor group, and 1 in the observational group), and 2 were infected during the breast-feeding period (in the NRTI group). Treatment- limiting adverse events occurred in 2% of women in the NRTI group, 2% of women in the protease-inhibitor group, and 11% of women in the observational group."

The authors concluded: "All regimens of HAART from pregnancy through 6 months post partum resulted in high rates of virologic suppression, with an overall rate of mother-to-child transmission of 1.1%."

All were effective so considerations such as cost and convenience should predominate in decisions regarding which to use.

For the full abstract, click here.

N Engl J Med 362(24):2282-2294, 17 June 2010 © 2010 to the Massachusetts Medical Society
Antiretroviral Regimens in Pregnancy and Breast-Feeding in Botswana. R.L. Shapiro, M.D. Hughes, A. Ogwu, et al. Correspondence to Dr. Shapiro: [email protected]

Category: W. Pregnancy, Childbirth, Family Planning, B. Blood/Blood Forming Organs/Immune Keywords: HIV-1, pregnancy, breastfeeding, therapy, transmission, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 6 July 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.