Longer-term Maternal Perinatal Zidovudine Prophylaxis May Prevent HIV Transmission by Breast-feeding During Early Postnatal Period

Perinatal zidovudine/ ZDV (Retrovir) prophylaxis decreases rates of perinatal transmission of HIV-1. Its relationship with levels of HIV-1 RNA in breast milk and postnatal transmission in breast-fed African children is unknown.

At day 8 after delivery, levels of HIV-1 RNA in breast milk from 28 women who transmitted HIV-1 (Ts) postnatally and from 130 women who did not transmit HIV-1 (NTs) were lower for women receiving ZDV than for women receiving placebo.

Levels of HIV-1 RNA in breast milk remained low over time in NTs but increased by 816-fold in Ts treated with ZDV from baseline to days 45/90 after delivery.

Levels of HIV-1 RNA in breast milk at day 8 after delivery and the increase in levels of HIV-1 RNA in breast milk from day 8 to days 45/90 after delivery were independently associated with postnatal transmission.

An increase in the levels of HIV-1 RNA in breast milk from day 8 to 45 after delivery was associated with maternal ZDV prophylaxis.

Conclusions

”Strategies that limit postnatal breast-feeding or maintain effective antiretroviral therapy in the mother and/or infant for the duration of breast-feeding may have a significant effect on postnatal transmission and the overall rate of MTCT of HIV-1.”

“The results of the present study, which has shown an effect of postnatal maternal ZDV prophylaxis on early levels of HIV-1 RNA in breast milk, suggest that longer-term maternal antiretroviral prophylaxis may be an option to prevent transmission by breast-feeding during the early postnatal period, when levels of HIV-1 RNA in breast milk are the highest.”

10/06/04

Reference
O Manigart and others (for the Diminution de la Transmission Mere-Enfant Study Group).  Effect of Perinatal Zidovudine Prophylaxis on the Evolution of Cell-Free HIV-1 RNA in Breast Milk and on Postnatal Transmission. The Journal of Infectious Diseases 190:1422-1428. October 15, 2004.