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ART for mothers eradicates HIV transmission risk in breast-fed infants

Study findings from a large clinical trial conducted in sub-Saharan Africa and India indicated healthy HIV-infected mothers assigned a triple-drug ART regimen nearly eradicated disease transmission to their babies by breast milk, according to a news release.

The analysis, reported at AIDS 2016 in Durban, South Africa, is a part of the Promoting Maternal and Infant Survival Everywhere (PROMISE) study. The ongoing study, funded by the NIH, supports 2015 WHO guidelines that recommend lifelong ART for all pregnant and breast-feeding women infected with HIV.

Taha E. Taha, MBBS, MCM, MPH, PhD, professor and co-director in the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues enrolled 2,431 mother-child pairs living in resource-limited areas in which the mother was living with HIV and breast-feeding. The study was conducted in South Africa, Malawi, Tanzania, Uganda, Zambia, Zimbabwe and India over a 3-year period. The mean HIV-infected mother demonstrated a healthy immune system with high CD4+ cell levels and no symptoms of the virus.

The researchers randomly assigned the pairs into two groups: mothers who received triple-ART for the following period and infants who received daily doses of nevirapine for 6 weeks postpartum, and mothers who received triple-ART until 1 week postpartum and infants who received nevirapine in daily doses from 1 week postpartum until follow-up was completed. The researchers followed the participants for 18 months or until mothers finished breast-feeding (mean, 15 months).

A strong association between both methods of intervention and infants who remained unaffected by HIV was observed. Further, there was no significant difference between HIV-transmission (called “very low”) in the two groups; 0.3% at 6 months and 0.6% at 1 year. Across the full study, nearly 99% of babies lived to their first birthday despite living in resource-limited countries.

“These findings add to the considerable body of evidence confirming the benefits of [ART] for every person living with HIV,” Anthony S. Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said in a press release. “Maternal [ART] safely minimizes the threat of HIV transmission through breast milk while preserving the health advantages of breast-feeding, as the high infant survival in this study underscores.”

African program reduces average HIV transmission rate to 2.1%

In a separate news release also presented at AIDS 2016, mothers2mothers (m2m), an African-based nongovernmental organization, reported that its peer mentor approach has reduced HIV mother-to-child HIV transmission to an average rate of 2.1% among its participants in 2015.

“m2m’s latest initiative is integrated adolescent health through its peer mentors who promote HIV counseling, testing and education in support of the goals of the DREAMS initiative, launched by the President’s Emergency Plan for AIDS Relief (PEPFAR),” according to the release.

The organization currently serves more than one in four pregnant women living with HIV in South Africa, Kenya, Malawi, Swaziland, Lesotho and Uganda. Last year, the program reached an estimated 860,500 participants via its facility-to-community platform. – by Kate Sherrer

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.

Reference:

Taha TE, et al. Comparing maternal triple antiretrovirals and infant nevirapine prophylaxis for the prevention of mother-to-child transmission of HIV during breastfeeding. Presented at: International AIDS Conference; July 18-22, 2016; Durban, South Africa.