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Maternal combo HAART, nursing regimen reduced risk for HIV transmission
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CHICAGO — Preliminary findings from the Aluvia study indicate that maternal lopinavir/ritonavir-based highly active antiretroviral therapy is effective in preventing mother-to-child transmission of HIV with supplemental nursing.
“This is the first study to support the new WHO recommendation,” said Mark Silverman, MD,assistant professor at the University of Toronto, who presented the 1-year results here. “This is what is considered ‘option B+,’ which is now taking place in some countries.”
WHO recommendations for infant feeding by HIV-positive mothers in developing countries now call for “exclusive breast-feeding until the age of 6 months, followed by supplemented breast-feeding until age 1 year.” Although previous data indicate that maternal HAART reduced the rate for HIV transmission during the period of exclusive nursing, whether supplemental nursing can be made safe using this approach was not yet known, according to background information in the study.
The current study included 225 HIV-positive women residing in Zimbabwe assigned zidovudine plus lamivudine plus lopinavir/ritonavir 400 mg and 100 mg tablets antepartum and for 12 months postpartum while nursing.
There were 230 live-born infants (several twins) and nine still births. Two infant deaths occurred between 6 months and 1-year postpartum. Thirteen women discontinued the study. Mean CD4 cell count was 353; mean age of gestational delivery was 38 weeks.
Four infants (2.1%) had a positive polymerase chain reaction test result at 6 weeks postpartum. Of 93 infants with age 1-year postpartum polymerase chain reaction results, 1.1% acquired HIV between 6 weeks and 1 year; one infant acquired HIV after 1 year (2%).
Of the two infants who acquired HIV-infection between 6 weeks and 1 year, their mothers reported discontinuation of treatment due to religious reasons and alcohol abuse. The one case that occurred after 1 year was due to the mother discontinuing treatment, but continuing breast-feeding.
“A regimen of maternal combination HAART for 12 months during initial exclusive breast-feeding for 6 months and then complementary feeding for 6 months can lower maternal to child transmission of HIV below the 5% goal,” Silverman said. “However, transmission may be greater during the period of complementary breast-feeding paired with exclusive breast-feeding and techniques to enhance adherence during this vulnerable time are necessary. Community education to enhance acceptance of breast-feeding is necessary in order to increase uptake of the new guidelines and to prevent families from pressuring women not to comply.” – by Jennifer Henry
For more information:
- Silverman M. #H1-1153. Presented at: the 2011 ICAAC; Sept. 17-20; Chicago.
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