Journal article
Maternal and Breastmilk Viral Load: Impacts of Adherence on Peripartum HIV Infections Averted-The Breastfeeding, Antiretrovirals, and Nutrition Study
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.73(5), pp.572-580
12/15/2016
DOI: 10.1097/QAI.0000000000001145
PMCID: 5141681
PMID: 27846071
Abstract
Background: Antiretroviral (ARV) interventions are used to reduce HIV viral replication and prevent mother-to-child transmission. Viral suppression relies on adherence to ARVs.
Methods: A 2-phase study was conducted using data from the Breastfeeding, Antiretrovirals, and Nutrition study. We included mothers randomized to 28 weeks of postpartum ARVs 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 ARV adherence significantly reduced the odds of having detectable (>= 40 copies/mL) breastmilk RNA, compared with poor adherence (Odds Ratio (OR) 0.23, 95% CI: 0.08 to 0.67; OR 0.36, 95% CI: 0.16 to 0.81, respectively). Detectable breastmilk RNA was associated with increased breastmilk transmission compared with undetectable breastmilk RNA (hazard ratio 3.8, 95% CI: 1.2 to 12.1). All transmitting mothers had >= 1 plasma viral load specimen >100 copies per milliliter. An estimated similar number of transmissions would occur with 90% adherence compared with 100%.
Conclusions: Helping patients adhere to ARVs throughout breastfeeding is important for realizing the full potential of recommended ARV interventions to prevent mother-to-child HIV transmission. Maintaining plasma viral load <100 copies per milliliter may prevent breastmilk transmission.
Details
- Title: Subtitle
- Maternal and Breastmilk Viral Load: Impacts of Adherence on Peripartum HIV Infections Averted-The Breastfeeding, Antiretrovirals, and Nutrition Study
- Creators
- Nicole L. Davis - University of North Carolina at Chapel HillWilliam C. Miller - University of North Carolina at Chapel HillMichael G. Hudgens - University of North Carolina at Chapel HillCharles S. Chasela - University of the WitwatersrandDorothy Sichali - Univ N Carolina, UNC Project, Lilongwe, MalawiDumbani Kayira - Univ N Carolina, UNC Project, Lilongwe, MalawiJulie A. E. Nelson - University of North Carolina at Chapel HillSusan A. Fiscus - University of North Carolina at Chapel HillGerald Tegha - Univ N Carolina, UNC Project, Lilongwe, MalawiDeborah D. Kamwendo - Univ N Carolina, UNC Project, Lilongwe, MalawiJoseph Rigdon - University of North Carolina at Chapel HillJeffrey S. A. Stringer - University of North Carolina at Chapel HillJonathan J. Juliano - University of North Carolina at Chapel HillSascha R. Ellington - Centers for Disease Control and PreventionAthena P. Kourtis - Centers for Disease Control and PreventionDenise J. Jamieson - Centers for Disease Control and PreventionCharles van der Horst - University of North Carolina at Chapel HillBreastfeeding, Antiretrovirals and Nutrition (BAN) Study Team
- Resource Type
- Journal article
- Publication Details
- JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, Vol.73(5), pp.572-580
- DOI
- 10.1097/QAI.0000000000001145
- PMID
- 27846071
- PMCID
- 5141681
- NLM abbreviation
- J Acquir Immune Defic Syndr
- ISSN
- 1525-4135
- eISSN
- 2331-6993
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- American Recovery and Reinvestment Act P30 AI050410 / University of North Carolina Center for AIDS Research NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Elizabeth Glaser Pediatric AIDS Foundation U.S. Agency for International Development; United States Agency for International Development (USAID) CDC; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA 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 5T32 AI070114 / Infectious Disease Epidemiology Training Grant National Institutes of Health (NIH); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA DHHS/NIH/FIC 2-D43 TW01039-06 / NIH Fogarty AIDS International Training and Research Program Gates Foundation; Bill & Melinda Gates Foundation World Food Program R56 AI091547; U01 AI068632 / 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 R24 TW007988 / Fogarty International Clinical Research Scholars Program; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC)
- Language
- English
- Date published
- 12/15/2016
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446540802771
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