Risk factors for early and late transmission of HIV via breast-feeding among infants born to HIV-infected women in a randomized clinical trial in Botswana

J Infect Dis. 2009 Feb 1;199(3):414-8. doi: 10.1086/596034.

Abstract

Risk factors for mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) via breast-feeding were evaluated in a randomized trial. HIV-infected women and their infants received zidovudine as well as single-dose nevirapine or placebo. Infants were randomized to formula-feed (FF) or breast-feed (BF) in combination with zidovudine prophylaxis. Of 1116 at-risk infants, 6 (1.1%) in the FF group and 7 (1.3%) in the BF group were infected between birth and 1 month (P=.99). Maternal receipt of nevirapine did not predict early MTCT in the BF group (P=.45). Of 547 infants in the BF group at risk for late MTCT, 24 (4.4%) were infected. Maternal HIV-1 RNA levels in plasma (P<.001) and breast milk (P<.001) predicted late MTCT. These findings support the safety of 1 month of breast-feeding in combination with maternal and infant antiretroviral prophylaxis. Trial registration. ClinicalTrials.gov identifiers: NCT00197691 and NCT00197652.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Botswana / epidemiology
  • Breast Feeding / adverse effects*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control
  • HIV Infections / transmission*
  • HIV-1* / genetics
  • HIV-1* / isolation & purification
  • Humans
  • Infant
  • Infant Formula
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical* / prevention & control
  • Milk, Human / virology
  • Nevirapine / therapeutic use
  • RNA, Viral / analysis
  • RNA, Viral / blood
  • Risk Factors
  • Zidovudine / therapeutic use

Substances

  • Anti-HIV Agents
  • RNA, Viral
  • Zidovudine
  • Nevirapine

Associated data

  • ClinicalTrials.gov/NCT00197652
  • ClinicalTrials.gov/NCT00197691