June 22, 2012

Prevention: Babies with HIV positive Mothers

(Ivanhoe Newswire) -- About 0.2% of pregnant women are HIV positive and 1/3 will pass the virus to their baby before it is born if no treatment is given. A new study breaches the safety and efficacy of adding antiretroviral drugs (HIV treatment drugs) to standard zidovudine prophylaxis (standard HIV prevention drugs) in infants of mothers with HIV who did not receive antenatal antiretroviral therapy because of late identification.

Within 48 hours after their birth, researchers randomly assigned formula-fed infants born to women with a peripartum diagnosis of HIV type 1 (HIV-1) infection to one of three regimens: zidovudine for 6 weeks (zidovudine-alone group), zidovudine for 6 weeks plus three doses of nevirapine during the first 8 days of life (two-drug group), or zidovudine for 6 weeks plus nelfinavir and lamivudine for 2 weeks (three-drug group).

A total of 1684 infants were enrolled in the Americas and South Africa. There were 566 in the zidovudine-alone group, 562 in the two-drug group, and 556 in the three-drug group. The overall rate of in utero transmission of HIV-1 was 5.7%, with no significant differences among the groups.

Intrapartum (during birth) transmission occurred in 24 infants in the zidovudine-alone group, as compared with 11 infants in the two-drug group, and 12 in the three-drug group. The overall transmission rate was 8.5%, with an increased rate in the zidovudine-alone group.

On multivariate analysis, zidovudine monotherapy, a higher maternal viral load, and maternal use of illegal substances were significantly associated with transmission. The rate of neutropenia was significantly increased in the three-drug group.

In newborns whose mothers did not receive antiretroviral therapy during pregnancy, prophylaxis with a two- or three-drug antiretroviral therapy regimen is superior to zidovudine alone for the prevention of intrapartum HIV transmission; the two-drug regimen has less toxicity than the three-drug regimen.

Source: New England Journal of Medicine, June 2012