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P3.173 Triple-antiretroviral prophylaxis to prevent mother-to-child hiv transmission through breastfeeding--the kisumu breastfeeding study, kenya: a clinical trial
  1. Njeri Mbugua1,
  2. Elizabeth Ann Bukusi2,
  3. Oyugi Julius Otieno3
  1. 1Kenya Medical Research Institute/Nairobi University/Kenyatta Hospital/Kenya Women With HIV/AIDS, Nairobi, Kenya
  2. 2Kenya Medical Research Institute/Nairobi University, Nairobi, Kenya
  3. 3Nairobi University, Nairobi, Kenya

Abstract

Introduction Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resource-limited settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and February 2009. The overall aim was to investigate whether a maternal triple-antiretroviral regimen that was designed to maximally suppress viral load in late pregnancy and the first 6 months of lactation was a safe, well-tolerated, and effective PMTCT intervention.

Methods and findings HIV-infected pregnant women took zidovudine, lamivudine, and either nevirapine or nelfinavir from 34–36 weeks‘ gestation to 6 months post partum. Infants received single-dose nevirapine at birth. Using Kaplan-Meier methods we estimated HIV-transmission and death rates from delivery to 24 months. We compared HIV-transmission rates among subgroups defined by maternal risk factors, including baseline CD4 cell count and viral load. Among 487 live-born, singleton, or first-born infants, cumulative HIV-transmission rates at birth, 6 weeks, and 6, 12, and 24 mo were 2.5%, 4.2%, 5.0%, 5.7%, and 7.0%, respectively. The 24-mo HIV-transmission rates stratified by baseline maternal CD4 cell count <500 and ≥500 cells/mm3 were 8.4% (95% confidence interval [CI] 5.8%–12.0%) and 4.1% (1.8%–8.8%), respectively (p=-0.06); the corresponding rates stratified by baseline maternal viral load <10 000 and ≥10 000 copies/ml were 3.0% (1.1%–7.8%) and 8.7% (6.1%–12.3%), respectively (p=0.01). None of the 12 maternal and 51 infant deaths (including two second-born infants) were attributed to antiretrovirals. The cumulative HIV-transmission or death rate at 24 mo was 15.7% (95% CI 12.7%–19.4%).

Conclusion This trial shows that a maternal triple-antiretroviral regimen from late pregnancy through 6 months of breastfeeding for PMTCT is safe and feasible in a resource-limited setting. These findings are consistent with those from other trials using maternal triple-antiretroviral regimens during breastfeeding in comparable settings.

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