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Highly Active Antiretroviral Therapy Versus Zidovudine for Prevention of Mother-to-Child Transmission in a Programmatic Setting, Botswana

Dryden-Peterson, Scott MD*,†,‡; Jayeoba, Oluwemimo MB, ChB; Hughes, Michael D. PhD§; Jibril, Haruna MD, MSc; Keapoletswe, Koona MSc; Tlale, Josephine MSc; Modise, Taolo A. Dip.Mid; Asmelash, Aida MD, MPH; Moyo, Sikhulile MSc, MPH; van Widenfelt, Erik BS; Makhema, Joseph MB, ChB, MPH; Essex, Max DVM, PhD†,‡; Shapiro, Roger L. MD, MPH†,‡; Lockman, Shahin MD, MSc*,†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2011 - Volume 58 - Issue 3 - p 353–357
doi: 10.1097/QAI.0b013e31822d4063
Brief Report: Epidemiology and Prevention

Few studies have compared the programmatic effectiveness of the recommended strategies of antenatal highly active antiretroviral therapy (HAART) and zidovudine for prevention of mother-to-child transmission. We prospectively followed infants (93% formula fed) whose mothers who took either HAART (258 infants) or zidovudine (170 infants) during pregnancy in the Botswana national program. Overall, 10 infants (2.5%) acquired HIV—9 infants in the zidovudine group (5.5%, 95% confidence interval: 2.6% to 10.2%) and 1 infant in the HAART group (0.4%, 95% confidence interval: 0.0% to 2.2%). Maternal HAART was associated with decreased prevention of mother-to-child transmission (P = 0.001) and improved HIV-free survival (P = 0.040) compared with zidovudine (with or without single-dose nevirapine) in a programmatic setting.

*Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA

Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana

Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA

§Department of Biostatistics, Harvard School of Public Health, Boston, MA

Department of HIV/AIDS Prevention and Care, Ministry of Health, Gaborone, Botswana

Department of Medicine, Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA

The authors S.D.P. and O.J. contributed equally to this work.

Supported by a research grant from the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354) which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, MCCAM, FIC, and OAR, and career development grants (to S.D.P) from the Fogarty International Center (R24 TW007988), BWF/American Society of Tropical Medicine Hygiene, and the Harvard Institute for Global Health.

Presented in part at the 18th Conference on Retroviruses and Opportunistic Infections, February 27 to March 2, 2011, Boston, MA.

M.D.H. is a paid member of Data and Safety Monitoring Boards for Boehringer Ingelheim, Medicines Development, Pfizer and Tibotec. The remaining authors declare that they do not have commercial or other association that might pose a conflict of interest.

Correspondence to: Dr Scott Dryden-Peterson, MD, Brigham and Women's Hospital, Division of Infectious Diseases, 75 Francis Street, Boston, MA 02115 (e-mail:

Received March 19, 2011

Accepted June 28, 2011

© 2011 Lippincott Williams & Wilkins, Inc.