[pronut-hiv] The overriding goal is to prevent HIV transmission

["Rachel Stern" <sternworks@verizon.net>]

Is the cost of this medicine subsidized? If so, couldn't the cost of formula be subsidized in the same way? True the overriding goal is to prevent HIV transmission, and antiretrovirals certainly do that, but these are potent drugs to be given daily to babies. Formula seems safer to me.



-----  "Mizan Siddiqi"wrote: 

>
>
> 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.
>
>
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