Large reductions in transmission of HIV-1 from mother to child have been achieved in more-developed countries due to the use of antiretroviral drug therapies. Short-course regimens, suitable for resource-poor countries, have also been shown to substantially reduce HIV-1 transmission around the time of childbirth. Joep Lange from the University of Amsterdam, Netherlands, and colleagues assessed the efficacy of short-course therapy with the antiretroviral drugs zidovudine and lamivudine in a predominantly breastfeeding population.
Around 1800 pregnant women with HIV-1 from South Africa, Tanzania, and Uganda were randomised into four groups: the first group received drug therapy targeting pre-delivery, labour, and post-delivery stages; the second during labour and after delivery; the third group received therapy only during labour, and the fourth group was given placebo.
The HIV-1 transmission rates from mother to child at six weeks after delivery were lowest for women given therapy before, during, and after delivery (5·7% for the first group, 8·9% for the second group, 14·2% for the third group, and 15·3% for the placebo group). Three-quarters of the women studied initiated breastfeeding. HIV-1 infection rates after 18 months were 15%, 18%, 20%, and 22% for the four groups, respectively.
Joep Lange comments: “Although therapy targeted at women before delivery, during labour, and after delivery was highly effective in reducing perinatal HIV-1 transmission, and should be one of the preferred short-course regimens wherever possible, triple drug combinations may be even more effective. However, introduction of short-course regimens to prevent mother-to-child transmission of HIV-1 in less-developed countries should be accompanied by interventions to minimise the risk of subsequent transmission via breastfeeding.”
In an accompanying Commentary (p 1168), Karen Palmore Beckerman from the University of California, San Francisco, USA, concludes: “The silence surrounding HIV disease and maternal health has been long-standing. Typical of perinatal prophylaxis trials, the PETRA report mentions no maternal-health endpoints and no maternal mortality data later than 6 weeks after birth. 10-15 years into the pandemic when these trials were conceived, treatment access and success had not been widely demonstrated or acknowledged anywhere in the world. Now, in the third decade of AIDS, HIV prevention and AIDS treatment can and must be integral parts of the global response to the AIDS catastrophe. What better place to start than with mothers and children?”
Contact: Professor Joep MA Lange, International Antiviral Therapy Center (IATEC),Dept of Human Retrovirology & Dept of Internal Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands; T) + 31 20 566 4479; F) + 31 20 691 8821/696 32; E) J.LANGE@AMC.UVA.NL
Dr Karen Palmore Beckerman, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco/San Francisco General Hospital, San Francisco, CA 94110, USA; E) kpb@itsa.ucsf.edu
Journal
The Lancet