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Antiretroviral Prophylaxis May Cut Breastfeeding HIV Spread

Most women reported weaning by 28 weeks; increased risk of adverse events after weaning

THURSDAY, April 26 (HealthDay News) -- Breastfeeding HIV-infected mothers are less likely to transmit the virus to their infants when either receive antiretroviral drugs, although weaning at six months may be detrimental, according to updated trial results published online April 26 in The Lancet.

Denise J. Jamieson, M.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues randomly assigned 2,369 HIV-infected breastfeeding mothers (CD4 count of at least 250 cells per µL) and their newborn babies in Malawi to receive maternal triple antiretroviral, daily infant nevirapine, or neither (control) for 28 weeks. All received a baseline regimen of single-dose nevirapine and seven days of zidovudine and lamivudine. Mothers were advised to wean their infants at 24 to 28 weeks.

The researchers found that follow-up was completed by 676 mother-infant pairs in the maternal-antiretroviral group, 680 in the infant-nevirapine group, and 542 in the control group. By 48 weeks, the cumulative risk of HIV-1 transmission was 7 percent in the control group, which was significantly higher than the maternal antiretroviral group and the infant nevirapine group (4 percent in each). Although most women reported weaning their infants by 28 weeks, 30 percent of infections occurred after 28 weeks. There was a significantly higher rate of adverse events after weaning, with a higher risk of diarrhea, malaria, slower growth, tuberculosis, and death.

"In resource-limited settings where no suitable alternative to breastfeeding is available, antiretroviral prophylaxis given to mothers or infants might decrease HIV transmission," Jamieson and colleagues conclude. "Weaning at six months might increase infant morbidity."

Several authors and/or their affiliations disclosed financial ties to the pharmaceutical industry. The antiretrovirals used in the study were donated by pharmaceutical companies.

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