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Issue No. 25 | June 13, 2008

News and Features

New Studies Test Effects of Breastfeeding and Extended Prophylaxis on HIV Infection and Infant Death

In two recent studies funded by the NIH and the CDC, researchers explored methods to prevent early death and HIV infection among breastfeeding infants born to HIV-infected mothers.

A study consisting of 958 HIV-infected mothers evaluated the effects of breastfeeding and found that early, abrupt breastfeeding cessation by HIV-infected mothers does not affect the rate of HIV infection in their newborns. Researchers also found that early weaning can increase the death rate of HIV-infected infants in low-resource settings.

A second study found that treating breastfeeding infants with an extended antiretroviral prophylaxis regimen decreases the risk of HIV infection. More than 3,000 mother/infant pairs took part in this trial. The study compared a control regimen (single dose nevirapine given to the mother during labor and to the infant at birth with daily doses of zidovudine given to the infant during the first week of life) with two extended regimens: extended nevirapine (control regimen plus daily nevirapine to 14 weeks of age) or extended dual prophylaxis (control regimen plus daily nevirapine and zidovudine to 14 weeks of age).  At 9 months of age, the estimated rate of HIV infection among infants was 10.6% in the control group, compared with 5.2% in the extended nevirapine group and 6.4% in the extended dual prophylaxis group.

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PI-Based Regimens Safe and Effective for Children

According to a recent study, protease inhibitor (PI)-based antiretroviral regimens are safe and effective in children. Children who received first-line PI-based regimens (including ritonavir, nelfinavir, or lopinavir/ritonavir) showed a significant reduction in viral load and an increase in CD4 count, regardless of the type of PI used.

Participants who stayed on their first treatment regimen had the best results, indicating that preventing regimen changes through adherence and other steps can lead to more successful HIV treatment. Out of 133 children, only 13 PI-associated toxicities required treatment changes or interruptions, demonstrating that PI-based regimens are tolerable and nontoxic in children. 

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