Antiretroviral regimen found to eliminate HIV transmission in breastfeeding women

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The danger or fear of transmission of HIV through breastfeeding may have be addressed or allayed in a recent clinical trial study conducted in sub-Saharan Arica and India for HIV-infected mothers whose immune system is in good health. The study found that taking a three-drug antiretroviral regimen during breastfeeding essentially eliminates HIV transmission by breast milk to their infants.

The Promoting Maternal and Infant Survival Everywhere (PROMISE) study was in line with the World Health Organization (WHO) guidelines introduced in 2015 that recommend lifelong antiretroviral therapy for all pregnant and breastfeeding women living with HIV. PROMISE investigators 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.

According to Anthony Fauci, maternal antiretroviral therapy safely minimizes the threat of HIV transmission through breast milk while preserving the health advantages of breastfeeding, as the high infant survival in this study underscores.
PROMISE began operation 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 perinatal HIV transmission during pregnancy and delivery.
The new findings stem from a component of PROMISE that compares the safety and efficacy of earlier two antiretroviral regimens for preventing mother-to-child transmission of HIV during breastfeeding. This component included mother-infant pairs living in resource-limited settings where breastfeeding is common and recommended for infant health. 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 diarrheal and respiratory infections.

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About 2,431 pairs of HIV-infected mothers and their HIV-uninfected infants were enrolled at clinical research sites in South Africa, Malawi, Tanzania, Uganda, Zambia, Zimbabwe and India between June 2011 and October 2014. Averagely, the women were asymptomatic and had relatively high CD4+ cell levels.The researchers randomly assigned the mothers and their newborns to one of two regimens. One regimen included triple-drug antiretroviral therapy for the mother that continued through the period of study follow up and daily doses of nevirapine for the infant until 6 weeks after.

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