Welcome to CDC stacks | Maternal and Breast Milk Viral Load: Impacts of Adherence on Peri-Partum HIV Infections Averted - the BAN Study - 43199 | CDC Public Access
Stacks Logo
Advanced Search
Select up to three search categories and corresponding keywords using the fields to the right. Refer to the Help section for more detailed instructions.
 
 
Help
Clear All Simple Search
Advanced Search
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.


Public Access Version Available on: December 15, 2017 information icon
Please check back on the date listed above.
Details:
  • Corporate Authors:
    for the Ban study team
  • Pubmed ID:
    27846071
  • Pubmed Central ID:
    PMC5141681
  • 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 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.

    Results

    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%.

    Conclusions

    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.

  • Document Type:
  • Collection(s):
  • 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
  • Supporting Files:
    No Additional Files
No Related Documents.
You May Also Like: