RE: [pronut-hiv] 3TC infant prophylaxis during breast-feeding reducesHIV infection rate at six months (3)

["Mizan Siddiqi" <msiddiqi@voxiva.net>]

The study has addressed important questions related to breastfeeding and
gives us further choice of drugs. It would be interesting to see which
period of breastfeeding got the protection most (e.g. 3 months vs. 5
months). The bottom line is that pregnant mothers and their babies must be
protected with a regimen that is compatible with exclusive breastfeeding and with lowest possible risk of transmission. Congratulations to the
investigators and look forward to see further studies on this important
issue.


Dr.Mizan Siddiqi
MBBS MSC DCH
Technical Advisor (Health, Nutrition and HIV/AIDS)
and Director M&E
Voxiva Inc.
1725 K Street NW Suite 900
Washington DC 20006
Tel. 202 419 0197 Fax:202 419 0131
 
Nkuoh Godlove wrote:

This is a very interesting study  I hope you could try this with other
regimemns that are used for  PMTCT like single dose nevirapine.

 Nkuoh Godlove


ProNut-HIV <pronut-hiv@healthnet.org> wrote:
Form Aidsmap
------------
IAS: 3TC infant prophylaxis during breast-feeding reduces HIV infection rate
at six months 
Keith Alcorn, Wednesday, August 03, 2005 

Daily dosing with 3TC (lamivudine, Epivir) for infants of HIV-positive
mothers reduces the risk that a baby will acquire HIV infection from its
mother through breast-feeding, according to the results of a joint
Tanzanian/Swedish study presented last week at the Third International AIDS
Society Conference on HIV Treatment and Pathogenesis in Rio de Janeiro,
Brazil. 

The MITRA study was conducted in Dar es Salaam, Tanzania's largest city. It
recruited pregnant HIV-positive women with a median age of 26 years and
median CD4 cell count of 419 cells/mm3. The vast majority of mothers were
asymptomatic (WHO stage 1: 89%), but 13.7% had CD4 cell counts below 200
cells/mm3 and thus had a high risk of transmitting HIV to their infants
perinatally. 

Mothers received treatment according to the PETRA trial protocol, which had
tested AZT/3TC (Combivir) given from week 36 of pregnancy until one week
after delivery as prophylaxis against mother-to-child transmission. Infants
received AZT/3TC for one week after birth, and then received daily treatment
with 3TC (4mg/kg) throughout the breast-feeding period. Mothers were
counselled to stop breast-feeding by six months after birth, although 22%
were still breast-feeding 26 weeks after birth. 

HIV infection was significantly less frequent in 3TC-treated infants at six
months compared to a historical control group of infants born to mothers who
participated in the original PETRA study. Infection was diagnosed using an
Amplicor HIV-1 DNA assay, which is the only reliable method of detecting HIV
infection in infants. 

4.9% of the 3TC-treated infants were HIV-positive by month six, compared to
11.9% of the historical control group (p=0.003). The rate of infection at
six months was only slightly higher than the infection rate at week six
among the 3TC-treated infants (3.4%). 

A potential limitation of this study is that the majority of mothers stopped
breast-feeding within six months of delivery, leading some experts to
suggest that it is difficult to disentangle the effect of early weaning from
the effect of 3TC. However the median duration of breast-feeding was 20
weeks, suggesting an extended period of risk for most infants. The research
group did not present any analysis of transmission risk according to
maternal baseline characteristics, particularly baseline CD4 cell count, and
there was no information on maternal viral load in plasma or breast milk, so
it is not possible to determine whether 3TC prophylaxis was more successful
for infants of mothers with less advanced HIV disease. 

Reference 

Kilewo C et al. Prevention of mother to child transmission of HIV-1 through
breastfeeding by treating infants prophylactically with lamivudine in Dar es
Salaam, Tanzania. Third International AIDS Society Conference on HIV
Treatment and Pathogenesis, Rio de Janeiro, abstract TuPe5.3P01, 2005.