June 24, 2010
HIV-positive mothers who receive antiretroviral therapy are likely to be able to breastfeed their newborns without passing on the virus, suggest the findings of two recent reports.
In a study from Botswana, 560 HIV 1-positive women who were randomized to three different regimens of highly active antiretroviral therapy administered from pregnancy through six-months postpartum had a combined rate of mother-to-child transmission of 1.1 percent. Women were randomized to a nucleoside reverse-transcriptase inhibitor group, a protease inhibitor group or an observational group that received nevirapine plus zidovudine-lamivudine.
All infants received single dose nevirapine and four weeks of zidovudine.
The authors described the transmission rates among the groups as similar, but noted that the study was not designed to compare rates among the groups.
In a separate study of 2,369 HIV 1-positive breastfeeding women in Malawi, researchers compared the efficacy of a maternal antiretroviral program and infant nevirapine in reducing HIV transmission. A control group received no extended postnatal antiretroviral regime.
Among the mother-infant pairs, 5.0 percent of infants were HIV-positive two weeks after birth. The risk of HIV transmission between week 2 and week 28 was 5.7 percent in the control group, 2.9 percent in the maternal regimen group (P=0.009) and 1.7 percent in the infant regimen group (P<0.001). The authors concluded that either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective for reducing HIV transmission during breastfeeding.
"Health care providers and mothers can ultimately choose the option that best suits their cultural, economic, and individual needs, since there is now evidence for two effective options to prevent the transmission of HIV-1 to infants from their mothers during breast-feeding in resource-limited countries," the authors concluded.
The full reports, "Antiretroviral Regimens in Pregnancy and Breast-Feeding in Botswana" and "Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission," were published in the New England Journal of Medicine (2010; 364(24):2282-2294 and 2271-2281).