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

Details

• Alternative Title:
  AIDS
• Personal Author:
  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
• 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.
  
  
• Keywords:
  Adherence Adolescent Adult Anti-Retroviral Agents Antiretroviral Breastfeeding Breast Feeding 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

  More +
• Source:
  AIDS. 28(18):2739-2749
• Pubmed ID:
  25493600
• Pubmed Central ID:
  PMC4397579
• Document Type:
  Journal Article
• Funding:
  D43 TW001039/TW/FIC NIH HHSUnited States/ ; U48-CCU409660-09/PHS HHSUnited States/ ; U48DP001944/ACL HHSUnited States/ ; U48-DP000059-01/DP/NCCDPHP CDC HHSUnited States/ ; R24 TW007988/TW/FIC NIH HHSUnited States/ ; P30-AI50410/AI/NIAID NIH HHSUnited States/ ; 5T32AI070114/AI/NIAID NIH HHSUnited States/ ; U48-DP001944-01/DP/NCCDPHP CDC HHSUnited States/ ; T32 AI070114/AI/NIAID NIH HHSUnited States/ ; U48 DP000059/DP/NCCDPHP CDC HHSUnited States/ ; 2-D43 TW01039-06/TW/FIC NIH HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/
• Volume:
  28
• Issue:
  18
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f38505ce877767d6115de5d7c730f869d4392255c6e4efa2c009eff7d0afa57c
• Download URL:
  https://stacks.cdc.gov/view/cdc/30387/cdc_30387_DS1.pdf
• File Type:
  [PDF - 809.84 KB ]