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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Maternal or infant antiretroviral drugs to reduce HIV-1 transmission
New England Journal of Medicine, Volume 362, No. 24, Year 2010
Notification
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Description
BACKGROUND: We evaluated the efficacy of a maternal triple-drug antiretroviral regimen or infant nevirapine prophylaxis for 28 weeks during breast-feeding to reduce postnatal transmission of human immunodeficiency virus type 1 (HIV-1) in Malawi. METHODS: We randomly assigned 2369 HIV-1-positive, breast-feeding mothers with a CD4+ lymphocyte count of at least 250 cells per cubic millimeter and their infants to receive a maternal antiretroviral regimen, infant nevirapine, or no extended postnatal antiretroviral regimen (control group). All mothers and infants received perinatal prophylaxis with single-dose nevirapine and 1 week of zidovudine plus lamivudine. We used the Kaplan-Meier method to estimate the cumulative risk of HIV-1 transmission or death by 28 weeks among infants who were HIV-1-negative 2 weeks after birth. Rates were compared with the use of the log-rank test. RESULTS: Among mother-infant pairs, 5.0% of infants were HIV-1-positive at 2 weeks of life. The estimated risk of HIV-1 transmission between 2 and 28 weeks was higher in the control group (5.7%) than in either the maternal-regimen group (2.9%, P=0.009) or the infant-regimen group (1.7%, P<0.001). The estimated risk of infant HIV-1 infection or death between 2 and 28 weeks was 7.0% in the control group, 4.1% in the maternal-regimen group (P=0.02), and 2.6% in the infant-regimen group (P<0.001). The proportion of women with neutropenia was higher among those receiving the antiretroviral regimen (6.2%) than among those in either the nevirapine group (2.6%) or the control group (2.3%). Among infants receiving nevirapine, 1.9% had a hypersensitivity reaction. CONCLUSIONS: The use of either a maternal antiretroviral regimen or infant nevirapine for 28 weeks was effective in reducing HIV-1 transmission during breast-feeding. (ClinicalTrials.gov number, NCT00164736.) Copyright © 2010 Massachusetts Medical Society.
Authors & Co-Authors
Chasela, Charles S.
Malawi, Lilongwe
Unc Project-malawi
Hudgens, Michael G.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Jamieson, Denise J.
United States, Atlanta
Centers for Disease Control and Prevention
Kayira, Dumbani
Malawi, Lilongwe
Unc Project-malawi
Hosseinipour, Mina C.
Malawi, Lilongwe
Unc Project-malawi
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kourtis, Athena P.
United States, Atlanta
Centers for Disease Control and Prevention
Martinson, Francis E.A.
Malawi, Lilongwe
Unc Project-malawi
Tegha, Gerald L.
Malawi, Lilongwe
Unc Project-malawi
Knight, Rodney J.
United States, Chapel Hill
Principia
Ahmed, Yusuf I.
United States, Atlanta
Centers for Disease Control and Prevention
Kamwendo, Deborah D.
Malawi, Lilongwe
Unc Project-malawi
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Hoffman, Irving F.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Ellington, Sascha R.
United States, Atlanta
Centers for Disease Control and Prevention
Kacheche, Zebrone K.
Malawi, Lilongwe
Unc Project-malawi
Soko, Alice
Malawi, Lilongwe
Unc Project-malawi
Wiener, Jeffrey B.
United States, Atlanta
Centers for Disease Control and Prevention
Fiscus, Susan A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kazembe, Peter Nicholas
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Mofolo, Innocent A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Chigwenembe, Maggie
Malawi, Lilongwe
Unc Project-malawi
Sichali, Dorothy S.
Malawi, Lilongwe
Unc Project-malawi
van der Horst, Charles Michael
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Statistics
Citations: 425
Authors: 22
Affiliations: 4
Identifiers
Doi:
10.1056/NEJMoa0911486
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Study Locations
Malawi
Participants Gender
Female