Options for pregnant and breast-feeding women, nursing babies all appear effective
WEDNESDAY, June 16 (HealthDay News) -- Various antiretroviral treatment options for lactating mothers and breast-feeding infants appear to reduce mother-to-child transmission of human immunodeficiency virus type-1 (HIV-1), according to two studies in the June 17 issue of the New England Journal of Medicine.
To ascertain the effectiveness of highly active antiretroviral therapy (HAART) in preventing HIV-1 transmission from mother to infant during pregnancy and breast-feeding, Roger L. Shapiro, M.D., of the Beth Israel Deaconess Medical Center in Boston, and colleagues randomized 560 HIV-1-positive women to one of two antiretroviral regimens: either abacavir, zidovudine, and lamivudine, or lopinavir-ritonavir plus zidovudine-lamivudine from 26 to 34 weeks' gestation until planned weaning by six months post-delivery. They found both approaches resulted in a high rate of virologic suppression, with a mother-to-infant transmission rate of 1.1 percent.
Charles S. Chasela, Ph.D., of the University of North Carolina Project in Lilongwe, Malawi, and colleagues randomly assigned 2,369 HIV-1-positive, breast-feeding women and their babies to maternal antiretroviral treatment, infant nevirapine, or no extended postnatal treatment (control group). They found the estimated risk of HIV-1 transmission or death in infants between 2 and 28 weeks of age to be 4.1 percent in the maternal-regimen group and 2.6 percent in the infant-regimen group, compared to 7.0 percent in the control group.
"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" Chasela and colleagues conclude.
Two authors of the second study disclosed financial ties to Abbott Laboratories and/or GlaxoSmithKline; these and other pharmaceutical and medical device companies provided funding for the study.
Abstract - Shapiro
Abstract - Chasela