Maternal or infant antiretroviral drugs to reduce HIV-1 transmission.
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Date
2010-06Author
Chasela, CS
Hudgens, MG
Jamieson, DJ
Kayira, D
Hosseinipour, MC
Kourtis, AP
Martinson, F
Tegha, G
Knight, RJ
Ahmed, Y
Kamwendo, DD
Hoffman, IF
Ellington, SR
Kacheche, Z
Soko, A
Wiener, JB
Fiscus, SA
Kazembe, P
Mofolo, IA
Chigwenembe, M
Sichali, DS
van der Horst, CM
BAN Study Group.
Meme, J
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
BACKGROUND:
We evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 (HIV-1) in Malawi.
METHODS:
We randomly assigned 2369 HIV-1-positive, breast-feeding mothers with a CD4+ lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen, infant nevirapine, or no extended postnatal antiretroviral regimen (control group). All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine. We used the Kaplan-Meier method to estimate the cumulative risk of HIV-1 transmission or death by 28 weeks among infants who were HIV-1-negative 2 weeks after birth. Rates were compared with the use of the log-rank test.
RESULTS:
Among mother-infant pairs, 5.0% of infants were HIV-1-positive at 2 weeks of life. The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group (5.7%) than in either the maternal-regimen group (2.9%, P=0.009) or the infant-regimen group (1.7%, P<0.001). The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0% in the control group, 4.1% in the maternal-regimen group (P=0.02), and 2.6% in the infant-regimen group (P<0.001). The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen (6.2%) than among those in either the nevirapine group (2.6%) or the control group (2.3%). Among infants receiving nevirapine, 1.9% had a hypersensitivity reaction.
CONCLUSIONS:
The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding. (ClinicalTrials.gov number, NCT00164736.)
Citation
N Engl J Med. 2010 Jun 17;362(24):2271-81. doi: 10.1056/NEJMoa0911486.Publisher
University of Nairobi
Collections
- Faculty of Health Sciences (FHS) [10377]