Prophylactic antiretroviral treatment of HIV-positive mothers or infants during breastfeeding

January 01, 0001

Prophylactic antiretroviral treatment of HIV-positive mothers or infants during breastfeeding

These investigators from the US and Malawi evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 (HIV-1). They randomly assigned 2369 HIV-1-positive, breast-feeding mothers with a CD4+ lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen, infant nevirapine, or no extended postnatal antiretroviral regimen (control group). All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine.

They found: "Among mother-infant pairs, 5.0% of infants were HIV- 1-positive at 2 weeks of life. The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group (5.7%) than in either the maternal-regimen group (2.9%) or the infant-regimen group (1.7%). The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0% in the control group, 4.1% in the maternal-regimen group, and 2.6% in the infant-regimen group. The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen (6.2%) than among those in either the nevirapine group (2.6%) or the control group (2.3%). Among infants receiving nevirapine, 1.9% had a hypersensitivity reaction."

The authors concluded: "The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding."

It is good to have 2 effective approaches.

For the full abstract, click here.

N Engl J Med 362(24):2271-228, 17 June 2010
© 2010 to the Massachusetts Medical Society
Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission. Charles S. Chasela, Michael G. Hudgens, Denise J. Jamieson, et al. Correspondence to Dr. van der Horst: [email protected]

Category: W. Pregnancy, Childbirth, Family Planning, B. Blood/Blood Forming Organs/Immune Keywords: HIV-1, antiretroviral treatment, breasfeeding, mothers, infants, 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.