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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission
AIDS, Volume 28, No. 18, Year 2014
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Description
Objective: Estimate association between postpartum antiretroviral adherence and breast milk HIV-1 transmission. Design: Prospective cohort study. Methods: Mother-infant pairs were randomized after delivery to immediately begin receiving 28 weeks of either triple maternal antiretrovirals (zidovudine, lamivudine, and either nevirapine, nelfinavir, or lopinavir-ritonavir) or daily infant nevirapine as part of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study. Associations between postpartum antiretroviral adherence and rate of breast milk HIV-1 transmission were estimated using Coxmodels.Wemeasured adherence over four postpartumtimeintervals using pill count, suspension bottle weight, and maternal self-report. Adherence was categorized and lagged by one interval. Missing adherence measures were multiply imputed. Infant HIV-1 infection was determined by DNA PCR every 2-6 weeks. The primary endpoint was infant HIV-1 infection by 38 weeks of age among infants alive and uninfected at 5 weeks. Results: Analyses included 1479 mother-infant pairs and 45 transmission events. Using pill count and bottle weight information, 22-40% of mother-infant pairs at any given interval were less than 90% adherent. Having at least 90% adherence was associated with a 52% [95% confidence interval (CI) 3-76] relative reduction in the rate of breast milk HIV-1 transmission, compared with having less than 90% adherence when controlling for study arm, breastfeeding status, and maternal characteristics. Complete case analysis rendered similar results (n=501; relative reduction 59%, 95% CI 6-82). Conclusion: Nonadherence to extended postpartum antiretroviral regimens in 'real world' settings is likely to be higher than that seen in BAN. Identifying mothers with difficulty adhering to antiretrovirals, and developing effective adherence interventions, will help maximize benefits of antiretroviral provision throughout breastfeeding. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Davis, Nicole L.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Miller, William C.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Hudgens, Michael G.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, Atlanta
Centers for Disease Control and Prevention
Chasela, Charles S.
South Africa, Johannesburg
University of the Witwatersrand
United States, Atlanta
Centers for Disease Control and Prevention
Sichali, Dorothy S.
Malawi, Lilongwe
University of North Carolina
United States, Atlanta
Centers for Disease Control and Prevention
Kayira, Dumbani
Malawi, Lilongwe
University of North Carolina
United States, Atlanta
Centers for Disease Control and Prevention
Nelson, Julie A.E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Stringer, Jeffrey S.A.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Ellington, Sascha R.
United States, Atlanta
Centers for Disease Control and Prevention
Kourtis, Athena P.
United States, Atlanta
Centers for Disease Control and Prevention
Jamieson, Denise J.
United States, Atlanta
Centers for Disease Control and Prevention
van der Horst, Charles Michael
United States, Chapel Hill
The University of North Carolina at Chapel Hill
United States, Atlanta
Centers for Disease Control and Prevention
Adair, Linda S.
United States, Atlanta
Centers for Disease Control and Prevention
Ahmed, Yusuf I.
United States, Atlanta
Centers for Disease Control and Prevention
Ait-Khaled, Mounir
United States, Atlanta
Centers for Disease Control and Prevention
Albrecht, Sandra S.
United States, Atlanta
Centers for Disease Control and Prevention
Bangdiwala, Shrikant I.
United States, Atlanta
Centers for Disease Control and Prevention
Bayer, Ronald
United States, Atlanta
Centers for Disease Control and Prevention
Bentley, Margaret E.
United States, Atlanta
Centers for Disease Control and Prevention
Bramson, Brian
United States, Atlanta
Centers for Disease Control and Prevention
Bobrow, Emily A.
United States, Atlanta
Centers for Disease Control and Prevention
Boyle, Nicola
United States, Atlanta
Centers for Disease Control and Prevention
Butera, Salvatore T.
United States, Atlanta
Centers for Disease Control and Prevention
Chavula, Charity
United States, Atlanta
Centers for Disease Control and Prevention
Chimerang'Ambe, Joseph
United States, Atlanta
Centers for Disease Control and Prevention
Chigwenembe, Maggie
United States, Atlanta
Centers for Disease Control and Prevention
Chikasema, Maria
United States, Atlanta
Centers for Disease Control and Prevention
Chikhungu, Norah
United States, Atlanta
Centers for Disease Control and Prevention
Chilongozi, David A.T.
United States, Atlanta
Centers for Disease Control and Prevention
Chiudzu, Grace
United States, Atlanta
Centers for Disease Control and Prevention
Chome, Lenesi
United States, Atlanta
Centers for Disease Control and Prevention
Cole, Anne
United States, Atlanta
Centers for Disease Control and Prevention
Corbett, Amanda H.
United States, Atlanta
Centers for Disease Control and Prevention
Corneli, Amy L.
United States, Atlanta
Centers for Disease Control and Prevention
Dow, Annae
United States, Atlanta
Centers for Disease Control and Prevention
Duerr, Ann C.
United States, Atlanta
Centers for Disease Control and Prevention
Eliya, Henry
United States, Atlanta
Centers for Disease Control and Prevention
Eron, Joseph J.
United States, Atlanta
Centers for Disease Control and Prevention
Farr, Sherry L.
United States, Atlanta
Centers for Disease Control and Prevention
Ferguson, Yvonne Owens
United States, Atlanta
Centers for Disease Control and Prevention
Fiscus, Susan A.
United States, Atlanta
Centers for Disease Control and Prevention
Flax, Valerie L.
United States, Atlanta
Centers for Disease Control and Prevention
Fokar, Ali
United States, Atlanta
Centers for Disease Control and Prevention
Galvin, Shannon R.
United States, Atlanta
Centers for Disease Control and Prevention
Guay, Laura A.
United States, Atlanta
Centers for Disease Control and Prevention
Heilig, Charles M.
United States, Atlanta
Centers for Disease Control and Prevention
Hoffman, Irving F.
United States, Atlanta
Centers for Disease Control and Prevention
Hooten, Elizabeth Gerken
United States, Atlanta
Centers for Disease Control and Prevention
Hosseinipour, Mina C.
United States, Atlanta
Centers for Disease Control and Prevention
Hurst, Stacy
United States, Atlanta
Centers for Disease Control and Prevention
Hyde, Lisa
United States, Atlanta
Centers for Disease Control and Prevention
Joaki, George R.F.
United States, Atlanta
Centers for Disease Control and Prevention
Jones, David
United States, Atlanta
Centers for Disease Control and Prevention
Jordan-Bell, Elizabeth
United States, Atlanta
Centers for Disease Control and Prevention
Kacheche, Zebrone K.
United States, Atlanta
Centers for Disease Control and Prevention
Kamanga, Esmie
United States, Atlanta
Centers for Disease Control and Prevention
Kamanga, Gift
United States, Atlanta
Centers for Disease Control and Prevention
Kampani, Coxcilly
United States, Atlanta
Centers for Disease Control and Prevention
Kamthunzi, Portia
United States, Atlanta
Centers for Disease Control and Prevention
Kamwendo, Deborah D.
United States, Atlanta
Centers for Disease Control and Prevention
Kanyama, Cecilia C.
United States, Atlanta
Centers for Disease Control and Prevention
Kashuba, Angela D.M.
United States, Atlanta
Centers for Disease Control and Prevention
Kathyola, Damson D.
United States, Atlanta
Centers for Disease Control and Prevention
Kazembe, Peter Nicholas
United States, Atlanta
Centers for Disease Control and Prevention
King, Caroline C.
United States, Atlanta
Centers for Disease Control and Prevention
Knight, Rodney J.
United States, Atlanta
Centers for Disease Control and Prevention
Krysiak, Robert G.
United States, Atlanta
Centers for Disease Control and Prevention
Kumwenda, Jacob
United States, Atlanta
Centers for Disease Control and Prevention
Lee, Hana
United States, Atlanta
Centers for Disease Control and Prevention
Loeliger, Edde
United States, Atlanta
Centers for Disease Control and Prevention
Long, Dustin M.
United States, Atlanta
Centers for Disease Control and Prevention
Luhanga, Misheck Richard
United States, Atlanta
Centers for Disease Control and Prevention
Madhlopa, Victor
United States, Atlanta
Centers for Disease Control and Prevention
Majawa, Maganizo
United States, Atlanta
Centers for Disease Control and Prevention
Maida, Alice
United States, Atlanta
Centers for Disease Control and Prevention
Marcus, Cheryl J.
United States, Atlanta
Centers for Disease Control and Prevention
Martinson, Francis E.A.
United States, Atlanta
Centers for Disease Control and Prevention
Thoofer, Navdeep K.
United States, Atlanta
Centers for Disease Control and Prevention
Matiki, Chrissie
United States, Atlanta
Centers for Disease Control and Prevention
Mayers, Douglas L.
United States, Atlanta
Centers for Disease Control and Prevention
Mayuni, Isabel
United States, Atlanta
Centers for Disease Control and Prevention
McDonough, Marita D.
United States, Atlanta
Centers for Disease Control and Prevention
Meme, Joyce
United States, Atlanta
Centers for Disease Control and Prevention
Merry, Concepta
United States, Atlanta
Centers for Disease Control and Prevention
Mita, Khama
United States, Atlanta
Centers for Disease Control and Prevention
Mkomawanthu, Chimwemwe
United States, Atlanta
Centers for Disease Control and Prevention
Mndala, Gertrude
United States, Atlanta
Centers for Disease Control and Prevention
Mndala, Ibrahim
United States, Atlanta
Centers for Disease Control and Prevention
Moses, Agnes
United States, Atlanta
Centers for Disease Control and Prevention
Msika, Albans
United States, Atlanta
Centers for Disease Control and Prevention
Msungama, Wezi
United States, Atlanta
Centers for Disease Control and Prevention
Mtimuni, Beatrice M.
United States, Atlanta
Centers for Disease Control and Prevention
Muita, Jane
United States, Atlanta
Centers for Disease Control and Prevention
Mumba, Noel
United States, Atlanta
Centers for Disease Control and Prevention
Musis, Bonface
United States, Atlanta
Centers for Disease Control and Prevention
Mwansambo, Charles C.V.
United States, Atlanta
Centers for Disease Control and Prevention
Mwapasa, Gerald
United States, Atlanta
Centers for Disease Control and Prevention
Nkhoma, Jacqueline R.
United States, Atlanta
Centers for Disease Control and Prevention
Parker, Megan E.
United States, Atlanta
Centers for Disease Control and Prevention
Pendame, Richard B.
United States, Atlanta
Centers for Disease Control and Prevention
Piwoz, Ellen G.
United States, Atlanta
Centers for Disease Control and Prevention
Raines, Byron N.
United States, Atlanta
Centers for Disease Control and Prevention
Ramdas, Zane
United States, Atlanta
Centers for Disease Control and Prevention
Ryan, Máirín A.A.
United States, Atlanta
Centers for Disease Control and Prevention
Sanne, Ian M.
United States, Atlanta
Centers for Disease Control and Prevention
Sellers, Christopher J.
United States, Atlanta
Centers for Disease Control and Prevention
Shugars, Diane C.
United States, Atlanta
Centers for Disease Control and Prevention
Snowden, Wendy B.
United States, Atlanta
Centers for Disease Control and Prevention
Soko, Alice
United States, Atlanta
Centers for Disease Control and Prevention
Spensley, Allison
United States, Atlanta
Centers for Disease Control and Prevention
Steens, Jean Marc
United States, Atlanta
Centers for Disease Control and Prevention
Tegha, Gerald L.
United States, Atlanta
Centers for Disease Control and Prevention
Tembo, Martin
United States, Atlanta
Centers for Disease Control and Prevention
Thomas, Roshan
United States, Atlanta
Centers for Disease Control and Prevention
Tien, Hsiaochuan
United States, Atlanta
Centers for Disease Control and Prevention
Tohill, Beth Carlton
United States, Atlanta
Centers for Disease Control and Prevention
Waalberg, Esther
United States, Atlanta
Centers for Disease Control and Prevention
Widen, Elizabeth Marie
United States, Atlanta
Centers for Disease Control and Prevention
Wiener, Jeffrey B.
United States, Atlanta
Centers for Disease Control and Prevention
Wilfert, Catherine M.
United States, Atlanta
Centers for Disease Control and Prevention
Wiyo, Patricia
United States, Atlanta
Centers for Disease Control and Prevention
Zimba, Chifundo Colleta
United States, Atlanta
Centers for Disease Control and Prevention
Statistics
Citations: 13
Authors: 122
Affiliations: 4
Identifiers
Doi:
10.1097/QAD.0000000000000492
ISSN:
02699370
Research Areas
Food Security
Genetics And Genomics
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Quantitative