Eliminating perinatal HIV infection with ARVs.
The other study, in Botswana, randomly assigned 560 HIV-positive pregnant women (CD4 count >200 cells/[micro]l) to receive two different combinations of ARVs from 26-34 weeks gestation through to planned weaning by six months after birth. 170 women received nevirapine plus zidovudine-lamivudine (the observational group). Infants received single-dose nevirapine and four weeks of zidovudine. The rate of virologic suppression was high and did not differ significantly among the three groups at delivery (96% in the NRTI group, 93% in the protease-inhibitor group, and 94% in the observational group) or throughout the breastfeeding period (92%, 93% and 95%, respectively). The overall rate of mother-to-child transmission was 1.1% at six months of age (8/709 live-born infants), with no significant difference between the transmission rates in each group. (2)
These findings show that it would be possible to eliminate new perinatal HIV infections globally with ARV treatment with universal access. Some important lessons can be gleaned from these trials. ARV regimens must start during pregnancy. Maternal and infant regimens were no less safe than control interventions, although the use of ARV in both infants and mothers is associated with drug-resistant virus in the few infants who become HIV-positive despite prophylaxis. WHO recommends two prophylaxis options for women who do not otherwise require ARVs; it is not yet known which is more effective. Success will be tied less to which regimen is provided than to the integration of services for women with HIV and their infants. (3)
(1.) Chasela CS, Hudgens MG, Jamieson DJ, et al. Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. New England Journal of Medicine 2010;362(24):2271-81.
(2.) Shapiro RL, Hughes MD, Ogwu A, et al. Antiretroviral regimens in pregnancy and breast-feeding in Botswana. New England Journal of Medicine 2010;362(24):2282-94.
(3.) Mofenson LM. Protecting the next generation--Eliminating perinatal HIV-1 infection. New England Journal of Medicine 2010;362(24):2316-18.
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|Title Annotation:||antiretroviral; Round Up: HIV and AIDS|
|Publication:||Reproductive Health Matters|
|Date:||Nov 1, 2010|
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