Effect of perinatal zidovudine prophylaxis on the evolution of cell-free HIV-1 RNA in breast milk and on postnatal transmission.
Perinatal zidovudine (ZDV) prophylaxis decreases rates of perinatal transmission of human immunodeficiency virus type 1 (HIV-1). Its relationship with levels of HIV-1 RNA in breast milk and postnatal transmission in breast-fed African children is unknown. At day 8 after delivery, levels of HIV-1 RNA in breast milk from 28 women who transmitted HIV-1 (Ts) postnatally and from 130 women who did not transmit HIV-1 (NTs) were lower for women receiving ZDV than for women receiving placebo. Levels of HIV-1 RNA in breast milk remained low over time in NTs but increased by 8-16-fold in Ts treated with ZDV from baseline to days 45/90 after delivery. Levels of HIV-1 RNA in breast milk at day 8 after delivery and the increase in levels of HIV-1 RNA in breast milk from day 8 to days 45/90 after delivery were independently associated with postnatal transmission. An increase in the levels of HIV-1 RNA in breast milk from day 8 to 45 after delivery was associated with maternal ZDV prophylaxis. The rebound in levels of HIV-1 RNA in breast milk after discontinuation of maternal antiretrovirals needs to be further explored--it may justify prolonging antiretroviral prophylaxis during the entire breast-feeding period.
Manigart
Olivier
O
Centre MURAZ, 01BP390 Bobo-Dioulasso, Burkina Faso, Cote d'Ivoire.
Crepin
Montcho
M
Leroy
Valeriane
V
Meda
Nicolas
N
Valea
Diane
D
Janoff
Edward N
EN
Rouet
Francois
F
Dequae-Merchadoux
Laurence
L
Dabis
Francois
F
Rouzioux
Christine
C
Van de Perre
Philippe
P
D000349:Africa / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D008895:Milk, Human / Q000821:virology*; D018743:Perinatal Care; D011247:Pregnancy; D012367:RNA, Viral / Q000032:analysis; D013997:Time Factors; D015215:Zidovudine / Q000627:therapeutic use*
D019380:Anti-HIV Agents; D012367:RNA, Viral; D015215:Zidovudine