HealthDay News — Infants being breastfed by HIV-positive mothers can effectively be protected from the infection in the six- 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 one 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 (eight and nine 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 two drug regimens there was no difference in infection rates (hazard ratio of lopinavir-ritonavir versus lamivudine, 0.90; 95 percent 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 percent 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.
1. Nagot N, Kankasa C, Tumwine JK, et al. Extended pre-exposure prophylaxis with lopinavir–ritonavir versus lamivudine to prevent HIV-1 transmission through breastfeeding up to 50 weeks in infants in Africa (ANRS 12174): a randomised controlled trial. Lancet. 2015;DOI: http://dx.doi.org/10.1016/S0140-6736(15)00984-8.