Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Nicole L. Davis; William C. Miller; Michael G. Hudgens; Charles S. Chasela; Dorothy Sichali; Dumbani Kayira; Julie A. E. Nelson; Jeffrey S. A. Stringer; Sascha R. Ellington; Athena P. Kourtis; Denise J. Jamieson; Charles van der Horst; Breastfeeding, Antiretrovirals and Nutrition (BAN) Study Team

doi:10.1097/QAD.0000000000000492

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Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Journal article

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Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Nicole L. Davis, William C. Miller, Michael G. Hudgens, Charles S. Chasela, Dorothy Sichali, Dumbani Kayira, Julie A. E. Nelson, Jeffrey S. A. Stringer, Sascha R. Ellington, Athena P. Kourtis, …

AIDS (London), Vol.28(18), pp.2739-2749

11/28/2014

DOI: 10.1097/QAD.0000000000000492

PMCID: 4397579

PMID: 25493600

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Abstract

Objective: Estimate association between postpartum antiretroviral adherence and breast milk 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 (BAN) study. Associations between postpartum antiretroviral adherence and rate of breast milk 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 less than 90% adherent. Having at least 90% adherence was associated with a 52% [95% confidence interval (CI) 3-76] relative reduction in the rate of breast milk HIV-1 transmission, compared with having less than 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: Nonadherence to extended postpartum antiretroviral 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 antiretroviral provision throughout breastfeeding. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Immunology

Infectious Diseases

Virology

Life Sciences & Biomedicine

Science & Technology

Details

Title: Subtitle: Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission
Creators: Nicole L. Davis - Univ N Carolina, Dept Epidemiol, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27599 USA
William C. Miller - Univ N Carolina, Dept Epidemiol, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27599 USA
Michael G. Hudgens - University of North Carolina at Chapel Hill
Charles S. Chasela - University of the Witwatersrand
Dorothy Sichali - Univ N Carolina, UNC Project, Lilongwe, Malawi
Dumbani Kayira - Univ N Carolina, UNC Project, Lilongwe, Malawi
Julie A. E. Nelson - University of North Carolina School of Medicine
Jeffrey S. A. Stringer - Univ N Carolina, Dept Obstet & Gynecol, Global Womens Hlth Div, Chapel Hill, NC 27599 USA
Sascha R. Ellington - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA USA
Athena P. Kourtis - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA USA
Denise J. Jamieson - Ctr Dis Control & Prevent, Div Reprod Hlth, Atlanta, GA USA
Charles van der Horst - University of North Carolina School of Medicine
Breastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
Resource Type: Journal article
Publication Details: AIDS (London), Vol.28(18), pp.2739-2749
DOI: 10.1097/QAD.0000000000000492
PMID: 25493600
PMCID: 4397579
NLM abbreviation: AIDS
ISSN: 0269-9370
eISSN: 1473-5571
Publisher: Lippincott Williams & Wilkins
Number of pages: 11
Grant note: 5T32AI070114 / Infectious Disease Epidemiology Training Grant Elizabeth Glaser Pediatric AIDS Foundation R24 TW007988 / NIH Fogarty AIDS International Training and Research Program (Fogarty International Clinical Research Scholars Program) U.S. Agency for International Development; United States Agency for International Development (USAID) SIP 13-01 U48-CCU409660-09; SIP 26-04 U48-DP000059-01; SIP 22-09 U48-DP001944-01 / Prevention Research Centers Special Interest Project of the Centers for Disease Control and Prevention Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA NIH Fogarty AIDS International Training and Research Program (American Recovery and Reinvestment Act) DHHS/NIH/FIC 2-D43 TW01039-06 / NIH Fogarty AIDS International Training and Research Program P30-AI50410 / University of North Carolina Center for AIDS Research World Food Program National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Malawi Ministry of Health and Population United Nations Children's Fund
Language: English
Date published: 11/28/2014
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446277802771

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