IBFAN AFRICA

International researchers, in collaboration with the Ministry of Health (MoH) of Botswana, have discovered that anti retroviral drugs given to pregnant and breastfeeding mothers reduce mother to child transmission of HIV by 99%, this is according to The New England Journal of Medicine. The ground breaking discovery, which is the lowest in Africa, was made after a clinical study led by Robert Shapiro, Associate Professor of Medicine at Harvard Medical School, researchers at the Harvard School of Public Health, Botswana Harvard Partnership and the MoH.

The study’s transmission rate of 1.1% was obtained after breastfeeding children to age six months. This is the lowest rate of mother to child transmission recorded in a study from Africa or among breast feeding infants.  The study further indicates that taking highly active antiretroviral therapy (HAART) from early in the third trimester of pregnancy through weaning prevents mother-to-child HIV transmission. Shapiro and colleagues found that with no drug protection, there's a 40 percent chance that an infected, breastfeeding mother will transmit the AIDS virus to her baby.

For the study, researchers "randomly assigned (560) women with CD4 cell counts of 200 or more to receive coformulated abacavir/zidovudine/lamivudine (the nucleoside reverse transcriptase inhibitor [NRTI] group) or lopinavir/ritonavir plus zidovudine/lamivudine (the protease inhibitor [PI] group). ART was started during pregnancy and continued through weaning or 6 months postpartum, whichever occurred first. In addition, 170 women with CD4 counts <200 cells/mm3 or an AIDS-defining illness received zidovudine, lamivudine, and nevirapine (the observational group). Infants in all three groups received single-dose nevirapine at birth and then zidovudine for 4 weeks.

According to the lead author Robert Shapiro “previous interventions using shorter or less comprehensive treatment regimes were unable to get rates below 5%. Without any intervention, the rate of infection would be at least 25 % by age six months”

The findings are good news for many HIV-infected mothers, who "were faced with a choice between breast-feeding and a high risk of infecting their children with HIV, or using formula and risking high infant morbidity and mortality from other diseases associated with not breast-feeding,” said Max Essex, a professor of health sciences and chair of the Harvard School of Public Health AIDS Initiative and coauthor of the study in a prepared statement. "This study provides a more satisfactory solution”.

In a separate study, published in the same issue of The New England Journal of Medicine, another group of researchers found that just providing infants with prophylactic antiretroviral during infancy can also reduce the chances they will contract HIV through breast-feeding.  According to Journal Watch Specialties, the study was conducted in Malawi; 2369 HIV-infected breast-feeding mothers with CD4 counts  250 cells/mm3 were randomized, along with their infants, to one of three groups: maternal ART, infant nevirapine, or no extended postnatal prophylaxis (controls). All the women and infants had received perinatal single-dose nevirapine plus 1 week of zidovudine and lamivudine, but — in line with standard of care at the time — no antepartum ART had been given. The main findings:

• The in utero transmission rate was 5%.

• Among infants who were HIV negative at 2 weeks, HIV-infection rates at 28 weeks were 70% lower in the infant prophylaxis group — and 49% lower in the maternal ART group — than in the control group.

• Among infants receiving nevirapine, 1.9% had hypersensitivity reactions.

Research leader van der Horst says the study also found that treating newborns directly with the sweet syrup may turn out to be the better strategy. He also says only two percent of infants in the study became infected with HIV through their mothers' breast milk. "People will see how easy it is to give the infants the daily dose of nevirapine.  And since we decreased transmission to such low levels, I think instead of 200-thousand babies getting infected every year, it will be down to less than a hundred babies," he said.

In conclusion these two pivotal studies demonstrate that ART— in either breast-feeding infants or lactating mothers — significantly decreases postnatal HIV transmission. To maximally reduce the risk for perinatal transmission, ART must be started during pregnancy, because of the time required to suppress viral load. When women do not receive ART during pregnancy, infant nevirapine may be particularly important in preventing early postnatal infection if the woman breast-feeds.