[pronut-hiv] Reuters Health: Extended Infant Prophylaxis Reduces HIV Transmission Via Breastfeeding

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Extended Infant Prophylaxis Reduces HIV Transmission Via Breastfeeding

By Deborah Mitchell

BOSTON (Reuters Health) Feb 05 - Up to 50% of postnatal HIV infections
from breastfeeding can be prevented by extending the standard nevirapine
prophylaxis regimen, African and Indian investigators working in
resource-poor settings reported Monday.

These studies and others presented here at the 15th Conference on
Retroviruses and Opportunistic Infections are the first well-controlled,
randomized clinical trials to look at the effects of antiretroviral
regimens, time of intervention, and resistance on infant outcomes,
according to panel leader Dr. Elaine Abrams of Columbia University in
New York.

The findings "are likely to influence CDC guidelines" for the postnatal
treatment of infants born to HIV-infected mothers in resource-poor
settings, she said. About 45% of all mother-to-child HIV infections in
poor countries are associated with breastfeeding.

In one study, Dr. Taha Taha of Johns Hopkins University in Baltimore
and his colleagues enrolled 3016 uninfected infants born to HIV-infected
mothers. In this phase III study, conducted in Blantyre, Malawi, the
infants were randomized to 14 weeks of nevirapine; 14 weeks of
nevirapine plus zidovudine; or to the current standard of care, a
standard single-dose of nevirapine.

Ninety percent of the infants in all three groups were breast-fed for 6
months, at which point the breastfeeding rates declined to about 30%.
At 9-month follow-up, the HIV transmission rates were reduced by 50% in
both intervention groups compared with the standard care group, Dr. Taha
reported. The protective effects of these regimens persisted to up to 18
months.

Both regimens were "quite safe" with no significant differences between
the two. Most deaths in both groups were due to gastroenteritis or
pneumonia.

Similar findings were reported by Dr. Jayagowri Sastry of BJ Medical
College in Pune, India, who presented her group's data on extended
nevirapine prophylaxis trials in Ethiopia, India and Uganda.
The three studies used the same protocol, with a total of 2024 infants
randomized at birth to a single 2-mg dose of nevirapine or a single 2-mg
dose of nevirapine followed by daily 5-mg nevirapine starting on day 8
through 6 weeks. All of the mothers received a single 200-mg nevirapine
dose during labor and all of the infants were breastfed for 6 months.
The extended-treatment group had a 46% reduced risk of HIV infection at
the 6-month study end-point, Dr. Sastry told conference attendees. The
combined risk of death and HIV transmission in the intervention group
compared with the control group was 3.7% vs. 8.4% at 6 weeks, and 8.0%
vs. 11.6% at 6 months.

Dr. Sastry and her colleagues conclude that an extended nevirapine
regimen is a safe and effective way to significantly reduce HIV
transmission via breastfeeding.

The addition of zidovudine to the nevirapine regimen does not appear to
provide any further benefits, Dr. Taha added.