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

- Add this to...
- Twitter
- Facebook
- Google Bookmarks
- LinkedIn

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

Language:

English

[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:

U48 DP001944/DP/NCCDPHP CDC HHS/United States
D43 TW001039/TW/FIC NIH HHS/United States
U48-CCU409660-09/PHS HHS/United States
U48-DP000059-01/DP/NCCDPHP CDC HHS/United States
R24 TW007988/TW/FIC NIH HHS/United States
P30-AI50410/AI/NIAID NIH HHS/United States
5T32AI070114/AI/NIAID NIH HHS/United States
U48-DP001944-01/DP/NCCDPHP CDC HHS/United States
T32 AI070114/AI/NIAID NIH HHS/United States
U48 DP000059/DP/NCCDPHP CDC HHS/United States
2-D43 TW01039-06/TW/FIC NIH HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States

Main Document Checksum:

[+]

Supporting Files:

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

No Related Documents.

You May Also Like:

Maternal and Breast Milk Viral Load: Impacts of Adherence on Peri-Partum HIV Infections Averted - the BAN Study

Personal Author:

Davis, Nicole L.; Miller, William C.; Hudgens, Michael G.; Chasela, Charles S.; Sichali, Dorothy; Kayira, Dumbani; Nelson, Julie A. E.; Fiscus, Susan A.; Tegha, Gerald; Kamwendo, Deborah D.; Rigdon, Joseph; Stringer, Jeffrey S. A.; Juliano, Jonathan J; Ellington, Sascha R.; Kourtis, Athena P.; Jamieson, Denise J; Van Der Horst, Charles;

Corporate Author:

for the Ban study team

Published:

Dec 15 2016

Source:

J Acquir Immune Defic Syndr. 73(5):572-580.

Description:

Background : Antiretroviral interventions are used to reduce HIV viral replication and prevent mother-to-child transmission. Viral suppression relies on adherence to antiretrovirals. : Methods : A two-phase study was conducted using data from the Bre...

File Type:

[PDF - 108.26 KB]
Antiretroviral drug concentrations in breastmilk, maternal HIV viral load, and HIV transmission to the infant: results from the BAN study

Personal Author:

Davis, Nicole L; Corbett, Amanda; Kaullen, Josh; Nelson, Julie A. E.; Chasela, Charles S; Sichali, Dorothy; Hudgens, Michael G; Miller, William C; Jamieson, Denise J; Kourtis, Athena P;

Published:

Apr 01 2019

Source:

J Acquir Immune Defic Syndr. 80(4):467-473

Description:

Background: : Concentration of antiretroviral (ARV) drug found in plasma, and amounts of drug excreted into breastmilk, may affect HIV viral load and potentially perinatal HIV transmission. : Methods: : In this cohort study with two-phase sampling, w...

Public Access
Available on:

April 01, 2020
Effect of postnatal HIV treatment on clinical mastitis and breast inflammation in HIV-infected breastfeeding women

Personal Author:

Zadrozny, Sabrina; Westreich, Daniel; Hudgens, Michael G.; Chasela, Charles; Jamieson, Denise J.; Martinson, Francis; Zimba, Chifundo; Tegha, Gerald; Hoffman, Irving; Miller, William C.; Pence, Brian W.; King, Caroline C.; Kourtis, Athena P.; Msungama, Wezi; van der Horst, Charles;

Corporate Author:

for the BAN Study Team

Published:

Feb 16 2017

Source:

Paediatr Perinat Epidemiol. 31(2):134-143.

Description:

Background : The relationship between mastitis and antiretroviral therapy among HIV-positive, breastfeeding women is unclear. : Methods : In the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study, conducted in Lilongwe, Malawi, 2369 mother-inf...

File Type:

[PDF - 221.09 KB]
The acceptance and feasibility of replacement feeding at 6 months as an HIV prevention method in Lilongwe, Malawi: Results from the BAN Study

Personal Author:

Parker, Megan E.; Bentley, Margaret E.; Chasela, Charles; Adair, Linda; Piwoz, Ellen G.; Jamieson, Denise J.; Ellington, Sascha; Kayira, Dumbani; Soko, Alice; Mkhomawanthu, Chimwemwe; Tembo, Martin; Martinson, Francis; van der Horst, Charles M.;

Published:

Jun 2011

Source:

AIDS Educ Prev. 23(3):281-295.

Description:

International guidelines recommend EBF to age 6 months among HIV-infected mothers choosing to breast-feed and cessation thereafter if replacement feeding is acceptable, feasible, affordable, sustainable, and safe. When mothers wean, they are challeng...

File Type:

[PDF - 64.10 KB]
Stopping the Control Arm in Response to the DSMB: Mother’s Choice of HIV Prophylaxis during Breastfeeding in the BAN Study

Personal Author:

Chavula, Charity; Long, Dustin; Mzembe, Enalla; Kayira, Dumbani; Chasela, Charles; Hudgens, Michael G.; Hosseinipour, Mina; King, Caroline C.; Ellington, Sascha; Chigwenembe, Margret; Jamieson, Denise J.; van der Horst, Charles;

Corporate Author:

for the BAN Study Team

Published:

Oct 25 2011

Source:

Contemp Clin Trials. 33(1):55-59

Description:

The Data and Safety Monitoring Board (DSMB) for the Breastfeeding, Antiretrovirals, and Nutrition study, a clinical trial aimed to prevent postnatal HIV transmission, recommended halting randomization to the enhanced standard-of-care (control) arm. T...

File Type:

[PDF - 297.45 KB]