Adherence to extended postpartum antiretrovirals is associated with decreased breastmilk HIV-1 transmission: Results of the BAN study

DAVIS, Nicole L.; MILLER, William C.; HUDGENS, Michael G.; CHASELA, Charles S.; SICHALI, Dorothy; KAYIRA, Dumbani; NELSON, Julie A. E.; STRINGER, Jeffrey S. A.; ELLINGTON, Sascha R.; KOURTIS, Athena P.; JAMIESON, Denise J; VAN DER HORST, Charles

doi:10.1097/QAD.0000000000000492

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Adherence to extended postpartum antiretrovirals is associated with decreased breastmilk HIV-1 transmission: Results of the BAN study

Published Date:

Nov 28 2014

Publisher's site:

http://dx.doi.org/10.1097/QAD.0000000000000492 New Site Icon

Source:

AIDS. 28(18):2739-2749.

[PDF-809.84 KB]

Details:

Personal Authors:

DAVIS, Nicole L. ; MILLER, William C. ; HUDGENS, Michael G. ; CHASELA, Charles S. ; SICHALI, Dorothy ; ... More ▼

Corporate Authors:

BAN study team

Keywords:

[+]

Pubmed ID:

25493600

Pubmed Central ID:

PMC4397579

Description:

Objective

Estimate association between postpartum antiretroviral adherence and breastmilk HIV-1 transmission

Design

Prospective cohort study

Methods

Mother-infant pairs were randomized after delivery to immediately begin receiving 28 weeks of either triple maternal antiretrovirals (zidovudine, lamivudine, and either nevirapine, nelfinavir, or lopinavir-ritonavir) or daily infant nevirapine as part of the Breastfeeding, Antiretrovirals, and Nutrition study. Associations between postpartum antiretroviral adherence and rate of breastmilk HIV-1 transmission were estimated using Cox models. We measured adherence over four postpartum time intervals using pill count, suspension bottle weight, and maternal self-report. Adherence was categorized and lagged by one interval. Missing adherence measures were multiply imputed. Infant HIV-1 infection was determined by DNA PCR every 2-6 weeks. The primary endpoint was infant HIV-1 infection by 38 weeks of age among infants alive and uninfected at 5 weeks.

Results

Analyses included 1479 mother-infant pairs and 45 transmission events. Using pill count and bottle weight information, 22-40% of mother-infant pairs at any given interval were <90% adherent. Having ≥90% adherence was associated with a 52% (95% CI 3-76%) relative reduction in the rate of breastmilk HIV-1 transmission, compared with having <90% adherence when controlling for study arm, breastfeeding status, and maternal characteristics. Complete case analysis rendered similar results (n=501; relative reduction 59%, 95% CI 6-82%).

Conclusion

Non-adherence to extended postpartum ART regimens in ‘real world’ settings is likely to be higher than that seen in BAN. Identifying mothers with difficulty adhering to antiretrovirals, and developing effective adherence interventions, will help maximize benefits of ARV provision throughout breastfeeding.

Document Type:

Journal Article

Collection(s):

CDC Public Access

Funding:

2-D43 TW01039-06/TW/FIC NIH HHS/United States
5T32AI070114/AI/NIAID NIH HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States
P30-AI50410/AI/NIAID NIH HHS/United States
R24 TW007988/TW/FIC NIH HHS/United States
U48-CCU409660-09/PHS HHS/United States
U48-DP000059-01/DP/NCCDPHP CDC HHS/United States
U48-DP001944-01/DP/NCCDPHP CDC HHS/United States

Supporting Files:

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	nihms-676171-f0001.jpg	image/jpeg
	nihms-676171.nxml	application/octet-stream
	NIHMS676171-supplement-Supplemental_material.docx	application/vnd.openxmlformats-officedocument.wordprocessingml.document

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