Treatment of Mothers and Children Greatly Reduces HIV Transmission to Newborns

July 17, 2003

Ed Susman

July 17, 2003 (Paris) — African researchers have found that use of antiretroviral therapy, starting in week 36 of pregnancy and continuing through the breast-feeding period, can reduce the risk of vertical HIV transmission.

According to the study presented here yesterday in the late-breaker session of the Second International AIDS Society Conference on HIV Pathogenesis and Treatment, such a program can dramatically cut the rate at which HIV is passed from mother to infant. The transmission rate in the study was decreased to 1% in the first four weeks after birth and later, said Joseph Vyankandondera, MD, from Centre Hospitalier in Kigali, Rwanda.

"These are the first data to show that mothers can safely breast-feed children...in the presence of HIV infection," said Dr. Vyankandondera, reporting on the Stopping Infection from Mother-to-child via Breast-feeding in Africa (SIMBA) trial. The 405 mothers in the study began taking zidovudine and didanosine at week 36; 397 of their infants were randomized to receive syrup containing either lamivudine or nelfinavir once daily for the first two weeks of life and the same dose twice daily until one month after the mothers stopped breast-feeding.

Dr. Vyankandondera said there were no significant differences between the two groups, and there was no control arm for ethical reasons. Overall, he said, 6% of the infants contracted HIV during the intrauterine period, 1% in the first 4 weeks after birth, and 1% later on. By six months after birth, he said, more than 90% of the infants are healthy and still being followed.

Joep Lange, MD, from the University of Amsterdam Academic Medical Center, one of the lead SIMBA researchers, said the switch in treatment from mothers to babies is a temporary measure until long-term therapy is widely available to everyone in underdeveloped countries. "Obviously, it would be much better to [continue to] treat the mothers," Dr. Lange said.

Breast-feeding is discouraged among HIV-positive women to avoid transmission of the virus to their infants, but in most African countries, avoidance of breast-feeding is not an option. Dr. Vyankandondera said there is a "stigma" attached to mother who uses formula or other feeding options, so the SIMBA study adds important information for those counseling women in Africa.

Although the study was done in Africa, Dr. Wainberg suggested that it has application in Western countries as well for women who do not discover their HIV status until late in their pregnancy.

Second IAS Conference. Presented July 16, 2003.

Reviewed by Gary D. Vogin, MD

Ed Susman is a freelance writer for Medscape.

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