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Treating breastfeeding babies to prevent HIV

HIV-positive women who breastfeed their babies are at high risk of passing the virus on to their infants. As many as 30 percent of the children who are infected with HIV today contracted the virus through breast milk.

But an important new study finds that newborns can be protected from infection with prolonged treatment with the antiretroviral drug nevirapine, which was found to be safe for the infants. The researchers concluded that babies treated for six months with the drug fared better than those who received the standard, 6-week course of treatment. The results of the study are significant and are likely to change international guidelines and clinical practices for babies born to HIV-infected mothers.

The study included more than 1500 mothers and their babies in four African countries - South Africa, Tanzania, Uganda and Zimbabwe - all of which have rates of HIV/AIDS. Yvonne Maldonado, MD, chief of pediatric infectious disease at Stanford, presented the results today at the Conference on Retroviruses and Opportunistic Infections, being held in Boston, Mass. Maldonado has been working for more than a decade in Zimbabwe on methods to prevent mother-to-transmission of the AIDS virus.

The study found that the treatment benefits for the infants were even more pronounced among those with mothers who weren’t getting antiretroviral therapy for their own health. The World Health Organization recommends that pregnant women who are HIV-positive receive this therapy when their CD4 count - or the number of infection-fighting T-cells - drops below 350. These treated women are less likely to pass on the virus to their offspring through breast milk.

But many pregnant women don’t get this treatment because their T cell counts are above 350, so their unborn children may be left vulnerable to HIV infection through breastfeeding. Now the study shows for the first time that treating the infants alone for six months or more can protect them.

"So this is a big leap,” Maldonado told me. “This study is the first to provide concrete evidence that even just infant prophylaxis without maternal treatment of ‘healthy’ HIV-infected women with high CD4 counts will work.”

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