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Washington: Taking a three-drug antiretroviral therapy
against HIV can prevent transmission of the virus from infected mothers to
their infants during breastfeeding, a new clinical trial conducted in
sub-Saharan Africa and India has found.
These findings from the ongoing
Promoting Maternal and Infant Survival Everywhere (PROMISE) study support the
World Health Organisation (WHO) guidelines introduced in 2015 that recommend
lifelong antiretroviral therapy for all pregnant and breastfeeding women living
with HIV.
Researchers found that both three-drug
maternal antiretroviral therapy and daily infant nevirapine were safe and
effective at preventing HIV transmission during breastfeeding. Overall, infant
mortality in the study was extremely low, with nearly all babies surviving
their first year of life.
These findings add to the considerable
body of evidence confirming the benefits of antiretroviral therapy for every
person living with HIV, said Anthony S Fauci, director of US National Institute
of Allergy and Infectious Diseases (NIAID).
Maternal antiretroviral therapy safely
minimises the threat of HIV transmission through breast milk while preserving
the health advantages of breastfeeding, as the high infant survival in this
study underscores, Fauci said.
PROMISE, which began in 2010, is a
multi-component study that aims to determine how best to safely reduce the risk
of HIV transmission from HIV-infected women to their babies during pregnancy,
delivery and after childbirth, while preserving the health of both mother and
child.
Study results reported in 2014
identified the superiority of a three-drug regimen for the mother over other
regimens for preventing prenatal HIV transmission during pregnancy and
delivery.
HIV-infected mothers in areas that
lack safe, clean water may be encouraged to breastfeed because of the health
benefits for the infant and the risk for infants from mixing formula with an
unsafe water supply.
Breastfeeding helps prevent
malnutrition, and antibodies from breast milk protect babies against
potentially life-threatening diarrhoeal and respiratory infections.
The researchers enrolled 2,431 pairs
of HIV-infected mothers and their HIV-uninfected infants at clinical research
sites in South Africa, Malawi, Tanzania, Uganda, Zambia, Zimbabwe and India
between June 2011 and October 2014.
They found that maternal three-drug
antiretroviral therapy, as well as infant nevirapine, offered protection against
HIV transmission from mother to child.
The rate of prenatal transmission did
not differ between the two study arms and was very low - 0.3 per cent at 6
months of age and 0.6 per cent at one year of age.
Longer an HIV mother breastfeeds the
child, the greater chances of it transmission. In comparison, in the absence of
any intervention, rates of HIV transmission from a HIV-infected mother to her
child during pregnancy, labour, delivery or breastfeeding historically have
ranged from 15 to 45 per cent, according to WHO.
PTI