Maternal HAART during breastfeeding confers a 43% RR reduction in mother-to-child transmission of HIV-11

The Kesho Bora (Swahili for ‘A better future’) Study, a multinational randomised control trial, evaluated the impact on mother-to-child transmission of highly active antiretroviral therapy (HAART; 300 mg zidovudine, 150 mg lamivudine and 400 mg lopinavir/100 mg ritonavir twice daily) up until a maximum of 6.5 months postpartum (n=412) versus 300 mg zidovudine twice daily until delivery and single dose 600 mg zidovudine plus 200 mg nevirapine at the onset of labour (n=412). Neonates received approximately 2 mg/kg nevirapine suspension within 72 h but no later than 7 days of birth.

The 824 women, with CD4 cell counts between 200 and 500 cells/μl, commenced treatment at 28–36 weeks gestation and gave birth to 805 singletons or first borns. Women were recruited between June 2005 and August 2008. To be in line with WHO guidelines, a significant protocol amendment took place in December 2006. This resulted in: (1) antiretroviral agents commencing before 28 weeks of gestation; (2) mothers in the zidovudine–nevirapine arm receiving a further 1 week of twice-daily 300 mg zidovudine plus 150 mg lamivudine; (c) all neonates received an additional 1 week of twice-daily 4 mg/kg zidovudine postpartum. All …