Collaborators
- Kesho Bora Study Group:
Nicolas Meda, Paulin Fao, Odette Ky-Zerbo, Clarisse Gouem, Paulin Somda, Hervé Hien, Patrice Elysée Ouedraogo, Dramane Kania, Armande Sanou, Ida Ayassou Kossiwavi, Bintou Sanogo, Moussa Ouedraogo, Issa Siribie, Diane Valéa, Sayouba Ouedraogo, Roseline Somé, François Rouet, Stanley Luchters, Marcel Reyners, Eunice Irungu, Christine Katingima, Mary Mwaura, Gina Ouattara, Kishor Mandaliya, Sammy Wambua, Mary Thiongo, Ruth Nduati, Judith Kose, Ephantus Njagi, Peter Mwaura, Brigitte Bazin, Claire Rekacewicz, Allan Taylor, Nicole Flowers, Michael Thigpen, Mary Glenn Fowler, Denise Jamieson, Jennifer S Read, Kirsten Bork-Simondon, Cécile Cames, Amandine Cournil, Patricia Claeys, Marleen Temmerman, Philippe Van de Perre, Pierre Becquart, Vincent Foulongne, Michel Segondy, Isabelle de Vincenzi, Philippe Gaillard, Tim Farley, Ndema Habib, Sihem Landoulsi
PMID: 20543706
DOI: 10.1097/QAI.0b013e3181e36634
Abstract
Objective: To assess the effectiveness and safety of antiretrovirals (ARVs) used for treatment or prophylaxis in a breastfeeding population of HIV-1-infected women (Burkina-Faso, Kenya, South Africa).
Methods: HIV-1-infected pregnant women with <200 CD4 cells per cubic millimeter or with World Health Organization stage 4 disease (cohort A) and asymptomatic women with >500 CD4 cells per cubic millimeter (cohort B) were enrolled into 2 prospective cohorts. Women with 200-500 CD4 cells per cubic millimeter were enrolled in a parallel randomized trial. Women in cohort A initiated antiretroviral therapy. Women in cohort B received zidovudine from 34 to 36 weeks gestation until delivery, with single-dose nevirapine in labor (cohort B). All children received single-dose nevirapine.
Results: Of 248 women enrolled, 111 (cohort A) and 125 (cohort B) infants alive at 24 hours after birth were analyzed. Sixty-nine percent and 42% of women had undetectable viral load at delivery, respectively. Ten children in each cohort died. The 18-month cumulative incidences of HIV-1 infection were 7.5% (95% confidence interval: 3.8% to 14.5%) (cohort A) and 5.8% (2.8% to 11.8%) (cohort B). Sixty-one percent (cohort A) and 78% (cohort B) were breastfed for a median duration of 20 weeks. Four children in cohort A and only 1 in cohort B became HIV-1 infected after 6 weeks of age.
Conclusions: Antiretroviral therapy initiated a median of 7 weeks before delivery in women with advanced HIV-1 disease was associated with a significant residual risk of HIV-1 transmission due to insufficient decrease in viral load by the time of delivery. Among women with >500 CD4 cells per cubic millimeter, the risk of breast-milk transmission was very low despite lack of postnatal prophylaxis.
Link
