Details:

Alternative Title:
AIDS
Publisher's site:
http://dx.doi.org/10.1097/QAD.0000000000000492
Personal Author:
DAVIS, Nicole L. ; MILLER, William C. ; HUDGENS, Michael G. ; CHASELA, Charles S. ; SICHALI, Dorothy ; ... More +
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 ; Less -
Corporate Authors:
BAN study team ;
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.
Subject:
[+]
Adherence
Adolescent
Adult
Anti-Retroviral Agents
Antiretroviral
Article
Breast Feeding
Breastfeeding
Cohort Studies
Disease Transmission, Infectious
Female
HIV Infections
HIV Transmission
Humans
Infant
Infant, Newborn
Male
Medication Adherence
Middle Aged
Milk, Human
PMTCT
Postpartum Period
Pregnancy
Prospective Studies
Young Adult

Source:
AIDS. 28(18):2739-2749
Pubmed ID:
25493600
Pubmed Central ID:
PMC4397579
Document Type:
Journal Article ;
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 ; ... More +
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 ; Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:f38505ce877767d6115de5d7c730f869d4392255c6e4efa2c009eff7d0afa57c
File Type:

Supporting Files

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  	NIHMS676171-supplement-Supplemental_material.docx	docx

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