HIV prophylaxis can prevent transmission to breastfeeding infants

HealthDay News — Infants being breastfed by HIV-positive mothers can effectively be protected from the infection in the 6- to 12-month period after birth by receiving up to 12 months of liquid formula HIV drugs, according to a report published online in The Lancet.

Nicolas Nagot, MD, from INSERM U 1058 in Montpellier, France, and colleagues conducted a randomized trial involving children born to HIV-1-infected mothers not eligible for antiretroviral therapy. HIV-1-uninfected breastfed infants aged 7 days were randomized to lopinavir-ritonavir or lamivudine up to 1 week after complete cessation of breastfeeding or age 50 weeks. Overall, 1,273 infants were enrolled and randomized and 1,236 were analyzed (615 assigned to lopinavir-ritonavir and 621 to lamivudine).

The researchers diagnosed 17 HIV-1 infections during the study period (8 and 9 in the lopinavir-ritonavir and lamivudine groups, respectively), resulting in cumulative HIV-1 infection of 1.4% and 1.5% in the lopinavir-ritonavir and lamivudine groups, respectively.

Across the 2 drug regimens there was no difference in infection rates (hazard ratio of lopinavir-ritonavir versus lamivudine, 0.90; 95% confidence interval, 0.35 to 2.34; P = 0.83). There was no between-group difference seen in clinical and biological serious adverse events (51% and 50% of infants in the lopinavir-ritonavir and lamivudine groups had a grade 3 to 4 event, respectively).

“Infant pre-exposure prophylaxis should be extended until the end of HIV-1 exposure and mothers should be informed about the persistent risk of transmission throughout breastfeeding,” the authors write.