Kilewo Charles, Karlsson Katarina, Massawe Augustine, Lyamuya Eligius, Swai Andrew, Mhalu Fred, Biberfeld Gunnel
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
J Acquir Immune Defic Syndr. 2008 Jul 1;48(3):315-23. doi: 10.1097/QAI.0b013e31816e395c.
To investigate the possibility of reducing mother-to-child transmission (MTCT) of HIV-1 through breast-feeding by prophylactic antiretroviral (ARV) treatment of the infant during the breast-feeding period.
An open-label, nonrandomized, prospective cohort study in Tanzania (Mitra).
HIV-1-infected pregnant women were treated according to regimen A of the Petra trial with zidovudine (ZDV) and lamivudine (3TC) from week 36 to 1 week postpartum. Infants were treated with ZDV and 3TC from birth to 1 week of age (Petra arm A) and then with 3TC alone during breast-feeding (maximum of 6 months). Counseling emphasized exclusive breast-feeding. HIV transmission was analyzed using the Kaplan-Meier survival technique. Cox regression was used for comparison with the breast-feeding population in arm A of the Petra trial, taking CD4 cell count and other possible confounders into consideration.
There were 398 infants included in the transmission analysis in the Mitra study. The estimated cumulative proportion of HIV-1-infected infants was 3.8% (95% confidence interval [CI]: 2.0 to 5.6) at week 6 after delivery and 4.9% (95% CI: 2.7 to 7.1) at month 6. The median time of breast-feeding was 18 weeks. High viral load and a low CD4 T-cell count at enrollment were associated with transmission. The Kaplan-Meier estimated risk of HIV-1 infection at 6 months in infants who were HIV-negative at 6 weeks was 1.2% (95% CI: 0.0 to 2.4). The cumulative HIV-1 infection or death rate at 6 months was 8.5% (95% CI: 5.7 to 11.4). No serious adverse events related to the ARV treatment of infants occurred. The HIV-1 transmission rate during breast-feeding in the Mitra study up to 6 months after delivery was more than 50% lower than in the breast-feeding population of Petra arm A (relative hazard=2.61; P=0.001; adjusted values). The difference in transmission up to 6 months was significant also in the subpopulation of mothers with CD4 counts>or=200 cells/microL.
The rates of MTCT of HIV-1 in the Mitra study at 6 weeks and 6 months after delivery are among the lowest reported in a breast-feeding population in sub-Saharan Africa. Prophylactic 3TC treatment of infants to prevent MTCT of HIV during breast-feeding was well tolerated by the infants and could be a useful strategy to prevent breast milk transmission of HIV when mothers do not need ARV treatment for their own health.
探讨在母乳喂养期间通过对婴儿进行预防性抗逆转录病毒（ARV）治疗来降低人类免疫缺陷病毒1型（HIV-1）母婴传播（MTCT）的可能性。
在坦桑尼亚进行的一项开放标签、非随机、前瞻性队列研究（米特拉研究）。
HIV-1感染的孕妇从孕36周直至产后1周，按照佩特拉试验的A方案接受齐多夫定（ZDV）和拉米夫定（3TC）治疗。婴儿从出生至1周龄接受ZDV和3TC治疗（佩特拉试验A组），然后在母乳喂养期间（最长6个月）仅接受3TC治疗。咨询重点为纯母乳喂养。采用Kaplan-Meier生存技术分析HIV传播情况。使用Cox回归与佩特拉试验A组的母乳喂养人群进行比较，同时考虑CD4细胞计数及其他可能的混杂因素。
米特拉研究中有398名婴儿纳入传播分析。分娩后第6周，HIV-1感染婴儿的估计累积比例为3.8%（95%置信区间[CI]：2.0至5.6），第6个月时为4.9%（95%CI：2.7至7.1）。母乳喂养的中位时间为18周。入组时病毒载量高和CD4 T细胞计数低与传播相关。6周时HIV阴性的婴儿在6个月时，Kaplan-Meier估计的HIV-1感染风险为1.2%（95%CI：0.0至2.4）。6个月时HIV-1累积感染或死亡率为8.5%（95%CI：5.7至11.4）。未发生与婴儿ARV治疗相关的严重不良事件。米特拉研究中分娩后长达6个月的母乳喂养期间HIV-1传播率比佩特拉试验A组的母乳喂养人群低50%以上（相对风险=2.61；P=0.001；校正后值）。在CD4计数≥200个细胞/微升的母亲亚组中，直至6个月时的传播差异也具有统计学意义。
米特拉研究中分娩后6周和6个月时的HIV-1母婴传播率是撒哈拉以南非洲母乳喂养人群中报告的最低水平之一。婴儿预防性使用3TC治疗以预防母乳喂养期间的HIV母婴传播，婴儿耐受性良好，当母亲自身健康不需要ARV治疗时，这可能是预防母乳传播HIV的一种有效策略。
