title: Postnatal HIV-1 transmission after cessation of infant extended antiretroviral prophylaxis and effect of maternal highly active antiretroviral therapy.
abstract: BACKGROUND
  The association between postnatal human immunodeficiency virus type 1 (HIV-1) transmission and maternal highly active antiretroviral therapy (HAART) after infant extended antiretroviral prophylaxis was assessed.
  
  
  METHODS
  A follow-up study was conducted for the Post-Exposure Prophylaxis of Infants trial in Blantyre, Malawi (PEPI-Malawi). In PEPI-Malawi, breast-feeding infants of HIV-infected women were randomized at birth to receive a either control regimen (single-dose nevirapine plus 1 week of zidovudine); the control regimen plus nevirapine to age 14 weeks; or the control regimen plus nevirapine and zidovudine to age 14 weeks. Infant HIV infection, maternal CD4 cell count, and HAART use were determined. Maternal HAART use was categorized as HAART eligible but untreated (CD4 cell count of <250 cells/microL, no HAART received), HAART eligible and treated (CD4 cell count of <250 cells/microL, HAART received), and HAART ineligible (CD4 cell count of 250 cells/microL). The incidence of HIV infection and the association between postnatal HIV transmission and maternal HAART were calculated among infants who were HIV negative at 14 weeks.
  
  
  RESULTS
  Of 2318 infants, 130 (5.6%) acquired HIV infection, and 310 mothers (13.4%) received HAART. The rates of HIV transmission (in cases per 100 person-years) were as follows: for the HAART-eligible/untreated category, 10.56 (95% confidence interval [CI], 7.91-13.82); for the HAART-eligible/treated category, 1.79 (95% CI, 0.58-4.18); and for the HAART-ineligible category, 3.66 (95% CI, 2.86-4.61). The HIV transmission rate ratio for the HAART-eligible/treated category versus the HAART-eligible/untreated category, adjusted for infant prophylaxis, was 0.18 (95% CI, 0.07-0.44).
  
  
  CONCLUSIONS
  Postnatal HIV transmission continues after cessation of infant prophylaxis. HAART-eligible women should start treatment early for their own health and to reduce postnatal HIV transmission to their infants.
authors.affiliation: Dept. of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., Baltimore, MD 21205, USA. ttaha@jhsph.edu
authors.forename: Taha E
authors.initials: TE
authors.lastname: Taha
authors.forename: Johnstone
authors.initials: J
authors.lastname: Kumwenda
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: George
authors.initials: G
authors.lastname: Kafulafula
authors.forename: Mary Glenn
authors.initials: MG
authors.lastname: Fowler
authors.forename: Michael C
authors.initials: MC
authors.lastname: Thigpen
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.forename: Newton I
authors.initials: NI
authors.lastname: Kumwenda
authors.forename: Lynne
authors.initials: L
authors.lastname: Mofenson
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D018890:Chemoprevention; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D019829:Nevirapine / Q000008:administration & dosage; D011247:Pregnancy; D055815:Young Adult; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D044966:Anti-Retroviral Agents; D015215:Zidovudine; D019829:Nevirapine