NEW YORK (Reuters Health) – Both maternal antiretroviral therapy (mART) and prolonged infant nevirapine prophylaxis (iNVP) safely help to prevent breastfeeding mothers from passing HIV-1 to their infants, according to long-term data from the PROMISE trial.
Both mART and iNVP are safe and effective for preventing transmission of the virus from mother to baby during breastfeeding, but past research has looked only at interventions lasting up to 12 months, Dr. Patricia Flynn of St. Jude Children’s Research Hospital in Memphis and her colleagues note in their December 11 report in the Journal of Acquired Immune Deficiency Syndromes.
“Because increased morbidity and mortality have been associated with weaning compared to continued breastfeeding through the second year of life in HIV-1 exposed infants, breastfeeding beyond 12 months, and interventions to reduce HIV-1 transmission during breastfeeding will be required to maximize infant HIV-1 free survival,” they add.
The PROMISE (Promoting Maternal Infant Survival Everywhere) trial included 2,431 breastfeeding, HIV-infected mothers with high CD4 counts (at least 350 cells/mm3) and their HIV-negative infants from 14 sites in sub-Saharan Africa and India. Mother-child pairs were enrolled six to 14 days postpartum and randomly assigned to receive mART or iNVP. Treatment continued for up to 18 months after delivery.
Seven infants in each study arm became infected with HIV (<0.6% in both groups). HIV-free survival at 24 months was 97.1% with mART and 97.7% with iNVP.
Median time to breastfeeding cessation was 16 months in both groups, and they had similar incidences of life-threatening and fatal adverse events. Fewer than 1% of women and 2% of babies stopped treatment because of toxicity.
World Health Organization guidelines recommend that everyone with HIV be on ART for life, Dr. Flynn and her team note. “Despite these recommendations, due to postpartum adherence problems, many women experience rebound viremia, resulting in continued postnatal transmission,” they add. The findings show that iNVP can be a safe, effective option when adherence to ART is difficult, they conclude.
Dr. Flynn was not available for an interview by press time.
SOURCE: http://bit.ly/2p25rUM
J Acquir Immune Defic Syndr 2017.
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