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ART prophylaxis decreased HIV transmission while nursing

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Antiretroviral prophylaxis administered to mothers or infants in Malawi decreased mother-to-child transmission of HIV while nursing, according to new findings published in The Lancet.

"There are many places in the world where there are no safe alternatives to [nursing], and breast milk is critical for young infants," Denise J. Jamieson, MD, of the CDC and the US Public Health Service, told Infectious Disease News. "This is a way to make [nursing] safer and to increase infant survival among infants born to HIV-infected women."

The Breastfeeding, Antiretrovirals and Nutrition (BAN) study took place between April 21, 2004, and Jan. 28, 2010, and included 2,369 nursing mothers with a CD4 count of at least 250 cells/mcL and their newborn babies. Participants were randomly assigned to one of three 28-week regimens: maternal triple ART, daily infant nevirapine or to a control group.

Primary outcome measure was HIV infection by 48 weeks in infants who were not infected by 2 weeks. Mothers were advised to wean between 24 and 28 weeks after birth. At 48 weeks, 676 mother-infant pairs in the maternal ART group, 680 in the infant-nevirapine group and 542 controls completed follow-up.

By 32 weeks, 96% of women in the intervention groups and 88% of women in the control group reported weaning by 28 weeks.

Thirty infants in the maternal ART group, 25 in the infant-nevirapine group and 38 controls acquired HIV between 2 and 48 weeks of life. Twenty-eight cases of HIV occurred after 28 weeks. HIV transmission risk by 48 weeks was highest among controls: 7% vs. 4% in the maternal ART group and 4% in the infant-nevirapine group.

"The take-home message is that giving ART to HIV-infected mothers or their babies prevents HIV transmission during [nursing]," Jamieson said. "This study is especially relevant in resource-limited settings. In the United States, formula is used and HIV-infected women are counseled not to breast-feed. But, in resource-limited settings, where there is no alternative to [nursing], giving ART during [nursing] can actually increase overall HIV survival for these patients."

References:

• Jamieson DJ. Lancet. 2012;doi:10.1016/S0140-6736(12)60321-3.

Disclosures:

• The researchers report no relevant financial disclosures.