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Early Weaning Risky for Babies, HIV+ Moms (CME/CE)
MedPageToday, 2012that treatment of either the mother or infant during the first six months of breastfeeding reduced the risk of HIV transmission, compared with no therapy.
In the current analysis, they looked at what happened when the babies were weaned at 6 months and treatment was stopped.
At the same time, he added, it's important to continue therapy as long as the baby is being breastfed in order to continue to prevent HIV transmission.
In the so-called BAN study -- for Breastfeeding, Antiretrovirals, and Nutrition -- 2,369 mother-and-infant pairs in which the mother was HIV-positive got the now-standard perinatal prophylaxis of a single dose of nevirapine (Viramune) and a week of nevirapine and lamivudine (3TC).
All of the mothers had a CD4-positive lymphocyte count of at least 250 cells per cubic millimeter and thus, by then-current standards, did not require anti-retroviral therapy for their own health.
After the first week, they were randomly assigned to no further treatment (the control group), to maternal therapy with a triple-drug regimen, or to infant treatment with nevirapine.
Between 24 and 28 weeks, van der Horst said, the mothers were asked to stop breastfeeding, but were supported with additional care to ensure the infants had adequate nutrition.
Despite that, the researchers found, the rate of serious adverse events in infants was markedly higher during weeks 29 through 48 than during the intervention phase.
Specifically, during the intervention phase, the overall rate of adverse events among the babies was 0.7 per 100 person weeks, which jumped significantly (at P <0.0001) to 1.1 per 100 person weeks after therapy was stopped.
The cumulative risk of transmission by 48 weeks was 7% in the control group, which was significantly higher (at P =0.027 and P =0.002, respectively) than the 4% seen in each of the treatment groups.
In contrast, the rates at the end of the intervention period had been 5.7% in the control group, 2.9% in the maternal-treatment group, and 1.7% in the infant-treatment group.