 |
Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers prophylactically with triple antiretroviral therapy in Dar es Salaam, Tanzania - the MITRA PLUS study
Presented by Charles Kilewo, Tanzania, United Republic of.
Kilewo C.1, Karlsson K.2, Ngarina M.1, Massawe A.1, Lyamuya E.1, Lipyoga R.1, Msemo G.1, Swai A.1, Mhalu F.1, Biberfeld G.2
1Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania, United Republic of, 2Swedish Institute for Infectious Disease Control (SMI) and Karolinska Institute, Stockholm, Sweden
Objectives: The main aim of this study was to investigate the possibility to reduce mother-to-child transmission (MTCT) of HIV-1 by treating HIV-1 infected women with triple antiretroviral therapy (ART) during late pregnancy and six months of breastfeeding.
Methods: An open-label, non-randomized, prospective study (MITRA PLUS) has completed enrollment of HIV-1 infected pregnant women and six months of follow up after delivery in Dar es Salaam. The women were treated with zidovudine (ZDV) + lamivudine (3TC) + nevirapine (NVP) during late pregnancy and breastfeeding (NVP was replaced by nelfinavir for mothers with adverse reactions on NVP). ARV treatment was initiated at 34 weeks of gestation or earlier if the woman presented with symptomatic HIV infection or had CD4 cell counts below 200/ml. The infant received ZDV + 3TC for one week after birth. Treatment of the mothers was stopped at six months except for those who needed ART for their own health. Mothers were counseled on exclusive breastfeeding and encouraged to stop at six months. HIV-1 infection was diagnosed in the children by the Amplicor HIV-1 DNA v 1.5 PCR assay. Transmission of HIV-1 was analyzed using the Kaplan Meier survival technique.
Results: There were 441 infants included in the survival analysis with regard to transmission of HIV-1. The cumulative proportion of HIV-1 infected infants was 4.1 % (95%CI 2.1%-6.0%) at 6 weeks and 5.0% (95%CI 3.2-7.0%) at 6 months. The median time of breastfeeding was 24 weeks.
Conclusions: These results show a low HIV-1 transmission rate for mothers given ZDV + 3TC + NVP in late pregnancy and during six months of breastfeeding. The strategy can be adopted by women in developing countries who intend to breast-feed their infants and has the advantage that mothers with low CD4 cell counts will benefit from the treatment for their own health.
Back to the session -
Back to the Programme-at-a-Glance
|
|