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Maternal ART Reduces Transmission of HIV through Breast-Feeding

In a study conducted in Botswana (and reported at IAS 2009), the rate of mother-to-child transmission was only 1% among breast-feeding women who received ART through 6 months postpartum.

Strategies are available to prevent HIV transmission during pregnancy and delivery, but less is known about reducing risk during breast-feeding. Now, data from the Mma Bana study — presented by Roger Shapiro and colleagues at the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention [Abstract WELBB101] — point to a possible intervention.

The study involved 730 HIV-infected women in Botswana who were pregnant at the time of enrollment and planned to breast-feed. Those with CD4 counts 200 cells/mm³ were randomized to receive AZT/3TC/abacavir (Trizivir) or AZT/3TC (Combivir) + lopinavir/ritonavir from the third trimester through planned weaning at 6 months postpartum. Those with CD4 counts <200 cells/mm³ received AZT/3TC + nevirapine during the second or third trimester and continued ART indefinitely. All infants received single-dose nevirapine at birth and 1 month of AZT.

Nearly all the women (97%) initiated breast-feeding, and about 70% continued for at least 5 months; as counseled, <1% continued breast-feeding beyond 6 months. More than 90% of each treatment group had viral loads <400 copies/mL at delivery and throughout breast-feeding. Seven cases of vertical transmission occurred in the study population through 6 months — five in utero and two during breast-feeding — yielding an overall transmission rate of 1%, the lowest ever reported for an HIV-infected breast-feeding population. Transmission rates were comparable across study groups. Eleven percent of women in the nevirapine group experienced treatment-limiting adverse events, compared with only 2% in the abacavir and lopinavir/r groups. Premature births were more common with lopinavir/r than with abacavir, and stillbirths occurred most often with nevirapine.

These data indicate that, regardless of the specific components, maternal ART is highly successful in preventing HIV transmission both in utero and during the first 6 months of breast-feeding. In areas where breast-feeding is necessary for infant survival, ART during pregnancy and for up to 6 months of breast-feeding should become the standard of care.

— Judith Feinberg, MD

Published in Journal Watch HIV/AIDS Clinical Care August 31, 2009

Reader Remarks:

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• Good News for Infant Feeding in Low Resource Setting
  Kafilat O. Oloyede, Global Initiative for Community Development Awareness (GLIDA), 1 Sep 2009 8:50 AM EST
  Thank you for the wonderful work you are doing, one of which is empowering the people with life-saving information.
  
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