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Title: Extended Infant Antiretroviral Prophylaxis Reduces HIV Risk During Breastfeeding
URL: http://www.pslgroup.com/dg/223142.htm
Doctor's Guide
June 6, 2008

BALTIMORE, Md -- June 6, 2008 -- In many resource-poor countries, infants born to mothers with HIV receive a single dose of nevirapine (NVP) and a 1-week dose of zidovudine (ZDV) to prevent transmission of HIV from the mother to her newborn. The results of a randomised trial led by researchers at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and the University of Malawi College of Medicine, Zomba, Malawi, found that extending the routine antiretroviral regimen can significantly reduce the risk of mother-to-child HIV transmission. The study is published in the New England Journal of Medicine.

The Malawi trial, known as PEPI (post-exposure prophylaxis of infants), followed 3,016 infants born to HIV-positive mothers. The infants and mothers were followed for 2 years. All infants received the standard care of a single dose of NVP and a 1-week dose of ZDV to prevent HIV infection. One group received an additional 14-week prophylaxis with NVP, while another received 14-week regimens of both NVP and ZDV.

Throughout the trial, the children who received the extended prophylactic regimens had consistently lower rates of HIV infection compared with children who received the standard care. At 9 months, 5.2% of infants receiving extended NVP, and 6.4% of infants receiving extended NVP and ZDV contracted HIV, compared with 10.6% of infants receiving the standard of care regimen. The frequency at which the mothers breastfed their children was similar between all 3 treatment groups.

"We know that breastfeeding in the first 6 months of life is extremely important for the child's health and survival, especially in resource poor countries. However, women with HIV face a difficult choice because they are also putting the child at risk for HIV," said Taha E. Taha, MD, PhD, senior author of the study, Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology. "Our findings clearly show that extended drug regimens can significantly reduce the risk of HIV transmission from breastfeeding."

According to the researchers, the proportion of infants experiencing adverse events from the medications was similar in all groups. However, infants who received extended NVP and ZDV more commonly experienced neutropenia.


SOURCE: Johns Hopkins University Bloomberg School of Public Health

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