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Daily antiretroviral therapy may prevent mother-to-child HIV transmission

A daily dose of antiretroviral syrup to breastfeeding infants or treating their HIV-infected mothers with highly active antiretroviral drugs could prevent mother-to-child HIV transmission.

Daily antiretroviral therapy may prevent mother-to-child HIV transmission
A daily dose of antiretroviral syrup to breastfeeding infants or treating their HIV-infected mothers with highly active antiretroviral drugs could be a safe way to prevent mother-to-child HIV transmission through breast milk, according to a study.

The Breastfeeding, Antiretrovirals and Nutrition (BAN) study, led by Dr Charles van der Horst from University of North Carolina at Chapel Hill, is the only large-scale, randomised trial comparing infant prophylaxis or maternal treatment to an enhanced standard-of-care arm in the prevention of HIV transmission through breast milk.

"This is an exciting development. We may be able to spare mothers in the developing world a horrible choice by offering them an effective method for preventing transmission of HIV during breastfeeding," said van der Horst.

The study was conducted in Lilongwe, Malawi at a single site.

Investigators randomly assigned a total of 2,367 mother-infant pairs to one of three treatment arms.

For both the interventions, the probability of HIV-infection was significantly lower than in the enhanced control arm.

Of the randomized infants, 4.9% were found to be HIV positive at birth.

Among infants who were HIV-free at one week old, 6.4% on the enhanced control arm were infected by 28 weeks, compared to 3.0% of the infants on the maternal treatment arm and 1.8% of the infants who received daily nevirapine syrup.

On examining the probability of HIV infection or death by 28 weeks postpartum, 7.6% of the infants on the enhanced control arm were HIV-infected or died compared to 4.7% of the infants on the maternal treatment arm, and 2.9% of the infants on the infant prophylaxis arm.

The results of the study give global and national policy makers the choice of which intervention (maternal or infant antiretroviral intervention) to implement based on the conditions and resources in their particular setting.

"We hope to see these results translated quickly into program and policy,' said van der Horst.

The findings of the study were presented at the International AIDS Conference.

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