Wednesday, February 2, 2011

WHO guidelines revised for HIV-positive mothers--triple therapy recommended

Laura Huaman

A recent article in the Lancet suggests that HIV-positive women are less likely to transmit the virus to their children if they receive antiretroviral triple therapy, even when they are not sick enough qualify for it.

Researchers followed 805 mother-baby pairs in Burkina Faso, Kenya, and South Africa. The pregnant women were enrolled at stage 1, 2, or 3 of HIV-1 infection, with CD4 cell counts between 200 and 500 cells per muL. Women at this stage of infection are not qualified for triple therapy in low-resource settings. The participants were randomly assigned to either triple ARV prophylaxis (zidovudine, lamivudine, and lopivanir plus ritonavir twice daily until the end of breastfeeding) or zidovudine and single-dose nevirapine. The babies received nevirapine at birth and zidovudine twice daily for one week after birth. The study’s endpoints were the infant’s HIV-negative status at six weeks, 12 months; HIV-negative status at 12 months in children who did not breastfeed; AIDS-free survival in mothers at 18 months; and adverse events in moms and babies.

The study found that triple ARV prophylaxis during pregnancy and breastfeeding is safe and reduces the risk of HIV mother-to-child transmission (MTCT). 43% of moms getting triple therapy were less likely to have transmitted HIV to their babies. WHO has revised its guidelines to recommend ARV prophylaxis to mom or baby during breastfeeding if the mother is not yet having ARV treatment for her own health.


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