News Release

Longer breastfeeding with extended ART could reduce mother-to-child HIV transmission and improve infant survival

Peer-Reviewed Publication

The Lancet_DELETED

Giving antiretroviral drugs to HIV-infected mothers or their babies is highly effective at preventing HIV transmission through breast milk. However, stopping breastfeeding early (before 6 months) does not protect these children from HIV infection and significantly increases their likelihood of illness, growth problems, and death, according to the long-term results of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) randomised trial published Online First in The Lancet.

"BAN re-emphasizes that breastfeeding is essential for infant survival and wellbeing. Early weaning is neither effective nor safe as an HIV prevention strategy", state Louise Kuhn from Columbia University, New York, USA, and Hoosen Coovadia from the University of Witwatersrand, Johannesburg, South Africa in an accompany Comment.

In 2010, initial results (at 28 weeks) of the BAN trial showed that giving antiretroviral drugs to 2369 HIV-positive breastfeeding mothers or their babies in Malawi for up to 6 months significantly reduced the transmission of HIV to the breastfeeding infant. Based in part on these results, WHO now recommends antiretroviral prophylaxis for HIV-infected mothers or their babies throughout breastfeeding.

Here, Denise Jamieson from the US Centers for Disease Control and Prevention and colleagues report the long-term (48 week) outcomes from the BAN trial, with a specific focus on the safety and effects of weaning and stopping of antiretroviral prophylaxis at 28 weeks after birth.

At 48 weeks, the cumulative risk of HIV transmission was significantly higher in the control group (7%) than in the maternal-antiretroviral (4%) or the infant-prophylaxis group (4%)*.

However, almost a third (30%) of babies became infected after most mothers had reported weaning their babies from breastfeeding (after 28 weeks), suggesting that the chances of transmitting the virus might actually increase as a result of early weaning.

Early weaning also resulted in significant increases in infant illness (diarrhoea, malaria, and tuberculosis), growth faltering, and death. Indeed, the rate of serious adverse events in babies was significantly higher during the 29 week follow-up period compared with the 28-week intervention phase.

Just one mother died (due to renal failure) in the maternal-antiretroviral group during the 48-week follow-up, compared with eight women in the control group (who did not receive antiretroviral prophylaxis), suggesting that antiretroviral therapy might contribute to improved maternal survival.

The authors conclude: "Infant or maternal prophylaxis effectively reduces postnatal HIV-1 transmission and this protective effect persists until after breastfeeding is stopped. However, transmission does occur after mothers report that they have weaned their infants, so breastfeeding with prophylaxis for longer than 28 weeks might be advantageous. Infant morbidity and mortality also increased after 28 weeks, suggesting that continued breastfeeding with prophylaxis given for an extended period could improve infant survival."

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Dr Denise Jamieson, US Centers for Disease Control and Prevention, Atlanta, USA. Via CDC Press Office T) +1 404 639 3286 E) media@cdc.gov

Dr Louise Kuhn, Columbia University, New York, USA. T) +1 212 305 2398 E) lk24@columbia.edu

Notes to Editors:

*676 mother–infant pairs completed follow-up to 48 weeks or reached an endpoint in the maternal-antiretroviral groups, 680 in the infant-nevirapine group, and 542 in the control group. Between 2 weeks and 48 weeks of life, 93 infants became infected with HIV: 30 in the maternal-antiretroviral group, 25 in the infant-nevirapine group, and 38 in the control group.


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