Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET012 nevirapine versus short-course zidovudine
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Date
2005Author
Chung, Michael H.
Kiarie, James N.
Richardson, Barbra A.
Lehman, Dara A.
Overbaugh, Julie
Stewart, Grace C. John
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
Objective: To compare the effect of perinatal regimens of short-course nevirapine
(HIVNET012)andzidovudine[Thai-CentersforDiseaseControlandPrevention(CDC)
regimen] on breast milk viral shedding and perinatal transmission during the first 6
weeks postpartum in a randomized clinical trial.
Design: Randomized clinical trial.
Methods: Pregnant HIV-1 seropositive women in Nairobi, Kenya who planned to
breastfeedwererandomizedtoHIVNET012orThai-CDCregimens.Twotofourbreast
milk samples were collected each week between delivery and 6 weeks postpartum.
Breast milk HIV-1 RNA was quantified using the Gen-Probe TMA assay. Infants were
tested for HIV-1 DNA at birth and 6 weeks.
Results: From March to October 2003, 76 women were enrolled and 795 breast milk
samples were collected from 60 women who were randomized and followed after
delivery. Between 3 and 21 days postpartum, nevirapine was associated with significantlygreatersuppressionofbreastmilklog10HIV-1RNA:days3to7(1.98versus2.42,
P¼0.1); days 8 to 14 (1.78 versus 2.48, P¼0.005); days 15 to 21 (1.90 versus 2.97,
P¼0.003). At 6 weeks, the HIV-1 perinatal transmission rate was significantly lower
among those who took nevirapine than zidovudine (6.8% versus 30.3%, P¼0.02).
Conclusions: Compared to a peripartum zidovudine regimen, nevirapine was significantly
more likely to decrease HIV-1 RNA in breast milk during the first week and
through the third week postpartum following single-dose administration, and corresponded
with decreased transmission risk at 6 weeks. Sustained breast milk HIV-1
suppression may contribute to the ability of nevirapine to decrease perinatal transmission
of HIV-1.
URI
http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/10276http://www.ncbi.nlm.nih.gov/pubmed/16103773
Citation
AIDS 2005, 19:1415–1422Subject
Africavertical transmission
mother-to-child transmission
HIV-1
perinatal transmission
nevirapine
zidovudine
Collections
- Faculty of Health Sciences (FHS) [10377]