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Abstract



Both maternal HAART and daily infant nevirapine (NVP) are effective in reducing HIV-1 transmission during breastfeeding in a randomized trial in Malawi: 28 week results of the Breastfeeding, Antiretroviral and Nutrition (BAN) Study

C. Chasela1, M. Hudgens2, D. Jamieson3, D. Kayira1, M. Hosseinipour1, Y. Ahmed3, G. Tegha1, R. Knight4, A.P. Kourtis3, D. Kamwendo1, I. Hoffman5, S. Ellington3, Z. Kacheche1, J. Wiener3, F. Martinson1, P. Kazembe6, I. Mofolo1, D. Long2, A. Soko1, S.B. Smith2, C. van der Horst7

Background: A randomized trial evaluated the safety and efficacy of maternal or infant antiretroviral (ARV) regimens, taken up to 28 weeks during breastfeeding in reducing rates of postnatal HIV-1 transmission among mother-infant pairs.
Methods: Entry criteria included HIV-1 infected mothers with CD4 > 250 cells/uL and infant birthweight ≥2000 grams. Intrapartum, mothers and infants received single dose nevirapine (NVP) and one week of twice-daily zidovudine/lamivudine (ZDV/3TC). In a 3x2 factorial design pairs were randomized within one week of birth to one of 3 ARV interventions: 1) maternal ZDV+3TC and lopinavir + ritonavir twice daily (MHAART), 2) infant NVP daily (INVP), or 3) no additional ARV (control), and 2 nutritional arms (with or without maternal nutritional supplement). Mothers breastfed exclusively for 24 weeks followed by rapid weaning. Kaplan-Meier method was used to estimate the cumulative risk of HIV infection or death at 28 weeks among infants who were HIV-1 free 1 week after birth. Rates were compared using the log-rank test, stratified by nutritional supplement.
Results: Among 2637 mother-infant pairs, in utero transmission as reflected by HIV-1 infection at 1 week was 4.9%. The estimated risk of HIV-1 transmission by 28 weeks in those uninfected at 1 week was higher in the control arm (6.4%) compared to either of the intervention arms (3.0% in MHAART (p=0.003) and 1.8% in INVP arm (p< 0.0001)). The estimated risk of HIV-1 transmission or death by 28 weeks was 7.6% in the control arm compared to 4.7% in the MHAART arm (p=0.03) and 2.9% in the INVP arm (p< 0.0001). Although this study was not powered to compare the two intervention arms, there was a trend favoring INVP prophylaxis in HIV free survival (p=0.07).
Conclusions: Either MHAART or INVP for 28 wks is effective in reducing HIV-1 transmission during breastfeeding.





5th IAS Conference on HIV Pathogenesis and Treatment
Abstract no. WELBC103


Suggested Citation
"C.Chasela, et al. Both maternal HAART and daily infant nevirapine (NVP) are effective in reducing HIV-1 transmission during breastfeeding in a randomized trial in Malawi: 28 week results of the Breastfeeding, Antiretroviral and Nutrition (BAN) Study . : 5th IAS Conference on HIV Pathogenesis and Treatment: Abstract no. WELBC103 "