ART use in mothers with low CD4 cell counts reduces breastfeeding transmission fivefold: Malawi

The use of antiretroviral therapy (ART) by breastfeeding mothers greatly reduced the risk of HIV transmission to their infants after a 14-week course of infant HIV prophylaxis was stopped, according to a study performed in Malawi and presented to the Sixteenth Conference on Retroviruses and Opportunistic Infections (CROI) on Tuesday. However, ART use did not significantly reduce transmission risk in mothers with CD4 cell counts above 250 cells/mm³.

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Breastfeeding in HIV-positive mothers in Botswana did not affect mortality

A controlled, randomised, prospective trial of 1200 HIV-positive mothers in Botswana found no differences in mortality between those who breastfed and those who formula fed. A trend toward faster declines in CD4 cell count began to emerge several years after cessation of breastfeeding, but this was not statistically significant and its significance is unknown.

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Maternal resistance to nevirapine following single dose reduced by AZT/ddI or one month's ART

Two Thai studies have provided further evidence that short courses of more than one antiretroviral drug after delivery almost eliminate the risk of nevirapine resistance in mothers when it is used to prevent mother-to-child transmission, thus preserving nevirapine as an option for maternal treatment when eventually needed.

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Kaletra superior to nevirapine-based ART for women already exposed to single-dose nevirapine

An antiretroviral regimen based on the boosted protease inhibitor lopinavir/ritonavir (Kaletra, or Aluvia) was significantly more effective than a nevirapine-containing regimen in mothers previously exposed to single-dose nevirapine, according to results from the randomised OCTANE study presented on Tuesday at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal.

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Nearly half of new infant HIV infections in Botswana may result from mothers infected during pregnancy or after delivery

In discussions of mother-to-child transmission of HIV, the assumption is often made that the mothers themselves were already HIV-positive at or before the time of becoming pregnant. This assumption was challenged at a Tuesday morning session on mother and child health issues at the Sixteenth Conference on Retroviruses and Opportunistic Infections in Montreal. Presenter Lydia Lu of the Centers for Disease Control, on behalf of a US/Botswana research team, estimated that over 40% of infants who acquired HIV via mother-to-child transmission (MTCT) in 2007 may have been born to mothers who became HIV-infected during pregnancy or in their first post-partum year, when they were likely to be breastfeeding.

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Hormonal contraception does not affect HIV progression in large international cohort

Previous analyses, including a cohort study in Kenya and secondary results from a randomised controlled trial in Zambia, have suggested that hormonal contraception may accelerate HIV disease progression in women not yet on antiretroviral treatment (ART). However, an analysis of a cohort of over 4500 women across multiple sites in Africa and elsewhere found no evidence that hormonal contraception affects mortality or disease progression. Elizabeth Stringer of the University of Alabama at Birmingham reported the findings to the Sixteenth Conference on Retroviruses and Opportunistic Infections last week on behalf of a research team from Zambia and the US.

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