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Triple ARV Prophylaxis Reduces Viral Load in Breast Milk

A combination of AZT, lamivudine, and nevirapine (AZT/3TC/NVP) taken from week 28 of pregnancy and up to one month after delivery resulted in significantly reduced HIV levels in breast milk// as compared to the HIV levels found in the breast milk of women who were not treated prophylactically.

The DREAM programme (Drug Resource Enhancement Against AIDS and Malnutrition) in Mozambique conducted this pilot study to examine the effect of using triple antiretroviral (ARV) therapy to reduce mother to child HIV transmission while breastfeeding. Participants in the study were 40 women from the DREAM programme (group A) who receive comprehensive HIV prevention and care services and 40 HIV-positive women from an antenatal clinic (group B) where HIV testing is not done and ARV prophylaxis is not offered.

Pregnant women in group A were enrolled into the study and began antiretroviral therapy at week 28 of pregnancy or as soon as possible after the first trimester. (If haemoglobin was < 8 g/dL, stavudine was substituted for AZT in order to limit the risk of AZT-associated anaemia.) In group B, women were tested for HIV at delivery, and if HIV-positive, were asked to participate. All infants received a single dose of NVP within 72 hours of birth. All mothers agreed to refrain from breastfeeding and free formula feeding was provided.

Breast milk was expressed manually five times a day and samples were analysed at delivery and seven days post partum. Plasma HIV-1 RNA measurements had a lower detection limit of 50 copies/mL; DNA measurements expressed as the number of HIV copies/106 had a limit of detection of 10 copies/106 cells.

The median age of the patients was 25 in group A and 26 in group B (overall range 15-39). In each group, 38 women had WHO stage 1 HIV disease and two had stage 2 disease. In group A, the pre-HAART median CD4 cell count was 538 cells/mm3 and women were on therapy for a median of 85 days (range 4-165). At d
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