Skip Navigation LinksHome > February 1, 2004 - Volume 35 - Issue 2 > Use of Antiretroviral Drugs to Prevent HIV-1 Transmission Th...
JAIDS Journal of Acquired Immune Deficiency Syndromes:
Epidemiology and Social Science

Use of Antiretroviral Drugs to Prevent HIV-1 Transmission Through Breast-feeding: From Animal Studies to Randomized Clinical Trials

Gaillard, Philippe PhD*; Fowler, Mary-Glenn MD†; Dabis, Francois PhD‡; Coovadia, Hoosen MD§; van der Horst, Charles MD¶; van Rompay, Koen DVM, PhD**; Ruff, Andrea MD††; Taha, Taha PhD††; Thomas, Tim MD‡‡; de Vincenzi, Isabelle PhD*; Newell, Marie-Louise PhD§§; Ghent IAS Working Group on HIV in Women and Children

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Abstract

The major remaining challenge in the prevention of mother-to-child transmission is the reduction of the risk in settings where breast-feeding is common. This review gives an update on ongoing or planned antiretroviral intervention studies in resource-limited settings that are aimed at reducing the risk of mother-to-infant HIV transmission during lactation. These strategies include antiretroviral therapy given to the mother to reduce viral load in plasma and breast milk as well as antiretroviral regimens providing prophylaxis to uninfected infants during the period of breast-feeding. The rationale for the interventions based on animal models and human studies is described as well as the study designs of clinical trials. Potential risks and benefits of these interventions to mothers and infants are also highlighted. Laboratory studies nested within several of these trials will provide a better understanding of the pathogenesis of postnatal HIV transmission and its potential prevention using antiretroviral drugs.

Prevention of mother-to-child HIV transmission (PMTCT) in resource-rich settings is one of the true successes in fighting the AIDS pandemic. For an HIV-infected pregnant woman receiving potent combination antiretroviral therapy over at least the last trimester of pregnancy, obstetric interventions, and who is able to avoid breast-feeding, the risk of having an infected infant is nearly eliminated to about 1%. 1,2 However, in resource-limited settings where the majority of HIV-infected women breast-feed due to cost constraints, cultural norms, stigma, and unsafe water supply, the risk of MTCT without any intervention is much higher, ranging from 30–45% at 24 months after delivery. 3 Even with short-course peripartum antiretroviral interventions such as zidovudine (ZDV), zidovudine/lamivudine (ZDV/3TC), or nevirapine (NVP), overall transmission at 12–24 months ranges from 16–23%. 4–6 One of the remaining challenges therefore is how to maximally reduce MTCT of HIV in settings where breast-feeding is common.

This review gives an update on ongoing or planned antiretroviral intervention studies in resource-limited settings that are aimed at reducing the risk of mother-to-infant HIV transmission during lactation. These strategies include antiretroviral therapy given to the mother to reduce viral load in plasma and breast milk as well as antiretroviral regimens designed to provide prophylaxis to the uninfected infant during the period of breast-feeding. The rationale for the interventions based on animal models and human studies is described as well as the study designs of clinical trials. Potential risks and benefits of these interventions to mothers and infants are also highlighted.

© 2004 Lippincott Williams & Wilkins, Inc.

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