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Antiretroviral Therapy Around Childbirth Reduces Risk Of Mother-To-Child HIV-1 Transmission (pp 1168, 1178)

April 04, 2002

Antiretroviral therapy given to women before, during, and after childbirth could be beneficial in reducing mother-to-child HIV-1 transmission in the first few weeks after delivery, suggest authors of a study in this week's issue of THE LANCET. However, this short-term benefit could be compromised unless new interventions are identified to prevent further mother-to-child HIV-1 transmission from breastfeeding.

Large reductions in transmission of HIV-1 from mother to child have been achieved in more-developed countries due to the use of antiretroviral drug therapies. Short-course regimens, suitable for resource-poor countries, have also been shown to substantially reduce HIV-1 transmission around the time of childbirth. Joep Lange from the University of Amsterdam, Netherlands, and colleagues assessed the efficacy of short-course therapy with the antiretroviral drugs zidovudine and lamivudine in a predominantly breastfeeding population.

Around 1800 pregnant women with HIV-1 from South Africa, Tanzania, and Uganda were randomised into four groups: the first group received drug therapy targeting pre-delivery, labour, and post-delivery stages; the second during labour and after delivery; the third group received therapy only during labour, and the fourth group was given placebo.

The HIV-1 transmission rates from mother to child at six weeks after delivery were lowest for women given therapy before, during, and after delivery (5·7% for the first group, 8·9% for the second group, 14·2% for the third group, and 15·3% for the placebo group). Three-quarters of the women studied initiated breastfeeding. HIV-1 infection rates after 18 months were 15%, 18%, 20%, and 22% for the four groups, respectively.

Joep Lange comments: "Although therapy targeted at women before delivery, during labour, and after delivery was highly effective in reducing perinatal HIV-1 transmission, and should be one of the preferred short-course regimens wherever possible, triple drug combinations may be even more effective. However, introduction of short-course regimens to prevent mother-to-child transmission of HIV-1 in less-developed countries should be accompanied by interventions to minimise the risk of subsequent transmission via breastfeeding."

In an accompanying Commentary (p 1168), Karen Palmore Beckerman from the University of California, San Francisco, USA, concludes: "The silence surrounding HIV disease and maternal health has been long-standing. Typical of perinatal prophylaxis trials, the PETRA report mentions no maternal-health endpoints and no maternal mortality data later than 6 weeks after birth. 10-15 years into the pandemic when these trials were conceived, treatment access and success had not been widely demonstrated or acknowledged anywhere in the world. Now, in the third decade of AIDS, HIV prevention and AIDS treatment can and must be integral parts of the global response to the AIDS catastrophe. What better place to start than with mothers and children?"

Lancet