Maternal and Breast Milk Viral Load: Impacts of Adherence on Peri-Partum HIV Infections Averted - the BAN Study
Published Date:Dec 15 2016
Source:J Acquir Immune Defic Syndr. 73(5):572-580.
Corporate Authors:for the Ban study team
Pubmed Central ID:PMC5141681
Funding:U48 DP001944/DP/NCCDPHP CDC HHS/United States
D43 TW001039/TW/FIC NIH HHS/United States
R56 AI091547/AI/NIAID NIH HHS/United States
U01 AI068632/AI/NIAID NIH HHS/United States
R24 TW007988/TW/FIC NIH HHS/United States
T32 AI070114/AI/NIAID NIH HHS/United States
U48 DP000059/DP/NCCDPHP CDC HHS/United States
P30 AI050410/AI/NIAID NIH HHS/United States
Antiretroviral interventions are used to reduce HIV viral replication and prevent mother-to-child transmission. Viral suppression relies on adherence to antiretrovirals.
A two-phase study was conducted using data from the Breastfeeding, Antiretrovirals and Nutrition study. We included mothers randomized to 28 weeks of postpartum antiretrovirals with ≥1 plasma or breastmilk specimen. All mothers who transmitted HIV to their infants from 2-28 weeks (n=31) and 15% of mothers who did not (n=232) were included. Adherence was measured by pill count [categorized as poor (0-80%), partial (81-98%) and near perfect (>98%)]. Associations between adherence and breastmilk RNA were assessed using mixed effects models. Cox models were used to estimate associations between breastmilk RNA and HIV transmission. Using Monte Carlo simulation, we estimated the number of transmissions that would occur had everyone randomized to maternal ARVs been 90% and 100% adherent.
Partial or near perfect antiretroviral adherence significantly reduced the odds of having detectable (≥40 copies/ml) breastmilk RNA, compared to poor adherence (OR 0.23, 95% CI 0.08-0.67; OR 0.36, 95% CI 0.16-0.81, respectively). Detectable breastmilk RNA was associated with increased breastmilk transmission, compared to undetectable breastmilk RNA (HR 3.8, 95% CI 1.2-12.1). All transmitting mothers had ≥1 plasma viral load specimen >100 copies/ml. An estimated similar number of transmissions would occur with 90% adherence compared with 100%.
Helping patients adhere to antiretrovirals throughout breastfeeding is important for realizing the full potential of recommended antiretroviral interventions to prevent mother-to-child HIV transmission. Maintaining plasma viral load <100 copies/ml may prevent breastmilk transmission.
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