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Breastfeeding women can reduce the risk of HIV transmission to infants
using an extended-dose regimen of nevirapine, according to an article
released on July 25, 2008 in The Lancet.
While highly active anti-retroviral therapy (HAART) can prevent
vertical transmission when administered to pregnant women, but access
to this therapy can be limited in certain regions where resources are
limited. Barring this, mothers can minimize the risk of transmitting
the disease to their children by finding safe infant feeding
alternatives. When these are not available, a single dose of the
antiretroviral nevirapine can be administered to mothers and children
within 72 hours of birth to reduce the transmission risk.
To explore another potential method, Professor Robert Bollinger and
colleagues at Johns Hopkins University, Addis Ababa University, BJ
Medical College, the National AIDS Research Institute in India, and
Makerere University performed three randomized trials in Ethiopia,
India, and Uganda. They hoped to determine whether nevirapine, when
administered daily to infants up to six weeks old, could decrease HIV
transmission via breastfeeding.
HIV-infected, breastfeeding mothers were randomized to one of two
groups: a single-dose nevirapine (SDN), with 200 mg nevirapine
administered to the women in labor, and 2 mg/kg given to newborns after
birth; or, extended-dose nevirapine (EDN), which had the SDN treatment
but an additional 5 mg administered daily between days 8 and 42 (6
weeks) for the infant. The researchers subsequently examined the
occurrence of HIV infection in the newborns at 6 months of age in
infants who had tested HIV-negative at birth.
In total, 986 SDN infants and 901 EDN infants were included in the
study. At six weeks, 54 SDN infants (5.5%) and 25 EDN children (2.8%)
tested HIV positive, forming a statistically significant reduction in
risk of 46% for the EDN group over the SDN group. At 6 months, 87 SDN
children (8.8%) and 62 EDN children (6.9%) tested HIV-positive, a
difference which is not statistically significant.
The authors conclude with the positive results of the trial, with ideas
for future improvement: "Although a 6-week regimen of daily nevirapine
might be associated with a reduction in the risk of HIV transmission at
6 weeks of age, the lack of a significant reduction in the primary
endpoint -- risk of HIV transmission at 6 months -- suggests that a longer
course of daily infant nevirapine to prevent HIV transmission via
breast milk might be more effective where access to affordable and safe
replacement feedings is not yet available and where the risks of
replacement feeding are high."
Dr Jeffrey Stringer and Dr Benjamin Chi, University of Alabama at
Birmingham, working from The Centre for Infectious Disease Research in
Zambia (CIDRZ), contributed an accompanying comment in which they say:
"Extended infant prophylaxis with nevirapine is simple enough to be
implemented almost anywhere. It represents a long-awaited, if partial,
solution to a mother's impossible choice. We should not delay."
However, it should be noted that one co-principal investigator from
India who was involved in the study disagrees with the way the paper
was interpreted and presented. Further details, including a letter from
the investigator and a comment given by the editors can be found in the
same issue of the Lancet.
Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV
transmission via breastfeeding in Ethiopia, India, and Uganda: an
analysis of three randomised controlled trials
Six Week Extended-Dose Nevirapine (SWEN) Study Team
Lancet 2008; 372: 300-13
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Written by Anna Sophia McKenney
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
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