[pronut-hiv] Reuters Health: Maternal HAART Reduces Breast Milk-Related HIV Infection

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

Maternal HAART Reduces Breast Milk-Related HIV Infection

By Deborah Mitchell

BOSTON (Reuters Health) Feb 05 - HIV transmission is significantly
reduced in infants born to HIV-infected mothers who are on highly active
antiretroviral therapy (HAART), when the infants are given a standard
single-dose of nevirapine at birth, according to a 4-year study
conducted in Kenya.

Dr. Timothy Thomas of the Centers for Disease Control and Prevention
presented the findings of the Kisumu Breastfeeding Study here at the
15th Conference on Retroviruses and Opportunistic Infections.
For this phase IIb study, the investigators put HIV-infected pregnant
women on a HAART regimen consisting of a single tablet containing
zidovudine and lamivudine plus nevirapine, starting at 34 weeks
gestation and continuing to 6 months postpartum.

The women were asked to exclusively breast-feed for 6 months and then
rapidly wean. Women with CD4 counts greater than 250 cells per
microliter were switched during the course of the study to nelfinavir.
The infants received a single-dose of nevirapine and were followed for
1 year. HIV infection rates were determined by PCR at delivery, 2, 6 and
14 weeks postpartum and after 6, 9 and 12 months. HIV infection data
were available for 497 infants.

At 1 week, 12 infants were HIV-positive, for a cumulative infection
rate of 2.4%, Dr. Thomas reported. By 1 year, the number of HIV
infections had risen to only 27 cases, for a cumulative infection rate
of 5.9%.
By comparison, the CDC estimates that mother-child HIV transmission
through breast-feeding in resource-poor settings ranges from 28% to
48%.
No differences in transmission rates were seen based on maternal CD4
counts or HAART regimen (nevirapine or nelfinavir).
These findings suggest that the 12-month HIV infection rate through
breast feeding can be substantially reduced by HAART initiated in late
pregnancy and continued through 6 months.
Dr. Thomas and his colleagues plan to further evaluate factors such as
treatment compliance, maternal and infant drug resistance, and optimal
timing of the intervention. Before implementation, it will also be
necessary to establish the safety, feasibility and patient acceptance of
HAART.<!--