Medical Advocates for Social Justice
Conference Abstract
from the
2nd IAS Conference on HIV and Pathogenesis
Paris, France

July 14-17, 2003
 

 

Reducing Risk of HIV-1 Transmission from Mother to Infant Through Breastfeeding Using Antiretroviral Prophylaxis in Infants  [Abstract LB7]

 J Vyankandondera1, S Luchters2. E Hassink2, N Pakker2, F Mmiro3,
P Okong4, P Kituuka5, C Ndugwa3, N Mukanka1, A Beretta6, M Imperiale Jr6,
E Loeliger7, M.Giuliano8, J Lange9; SIMBA Study 2003.
1. Centre Hospitalier de Kigali, Kigali, Rwanda; 2. International Antiviral Therapy Evaluation Center (IATEC), Amsterdam, the Netherlands; 3. Mulago Hospital, Kampala, Uganda; 4. St. Francis Hospital,
Kampala, Uganda; 5.Fondation Jacqueline Beytout, Paris, France; 6. Boehringer Ingelheim, Ridgefield,
USA; 7. GlaxoSmithKline, London; UK; 8. Istituto Superiore Di Sanità, Rome, Italy; 9. International Antiviral Therapy Evaluation Center (IATEC), Amsterdam, the Netherlands

 

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Background:
Since the introduction of short-course regimens for prevention of mother-to-child HIV-1 transmission in resource-constraint settings, breastfeeding (BF) increasingly accounts for transmission. We evaluated the efficacy of postnatal prophylaxis in infants with 3TC or NVP during the first 6 months of BF.

Methods:
In this randomised open-label trial in Uganda and Rwanda, live born infants of HIV-1 positive women, who had received zidovudine and didanosine from 36 wks gestation until 1 wk postpartum, were randomised to receive 3TC or NVP from birth until 1 month after cessation of BF. Regular counselling on exclusive BF was provided. Primary outcome was confirmed HIV-1 infection 6 months after birth based on HIV-1 DNA and RNA PCR from 4 weeks after birth onwards.

Results:
528 women were screened and 413 enrolled (medians: log10 HIV-1 RNA 2.66 cps/mL at delivery, CD4-count 427 c/mL and CDC status A 93% at baseline). 397 live born infants were randomised to 3TC (n=199) or NVP (n=198). Median days of BF was 107 (IQR:88-155) in the 3TC arm and 100 (IQR:89-145) in the NVP arm. Respectively, infants in 3TC and NVP arm were breastfed exclusively: 90.5% and 86.5%; mixed breast and bottle: 7.0% and 9.6%; exclusively bottle fed 2.5% and 3.5%.
Late postnatal transmission was observed in 1.1% of the infants (2/179) on 3TC and who were at risk after 4 wks of age and in 0.6% (1/179) on NVP (p=.6). Overall pre-, peri-, and postpartum HIV-1 infection over the first 6 months (KM method) was 10% (95%CI: 5-14%) and the combined risk of HIV-1 infection and death was 13% (95%CI: 8-18%). There were no differences between arms (p=.9 and p=.5, respectively).

Conclusions:
The combination of antiretroviral prophylaxis and counseling on breastfeeding practices in infants receiving breastfeeding from HIV-1 infected mothers is very effective in preventing mother to infant transmission. This finding could have considerable public health implications on breastfeeding practices for HIV-1 positive women.
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Reducing Risk of HIV-1 Transmission from Mother to Infant Through Breastfeeding
Using Antiretroviral Prophylaxis in Infants 
A Medical Advocates for Social Justice Update