Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial

Flynn, Patricia M.; Taha, Taha E.; Cababasay, Mae; Fowler, Mary Glenn; Mofenson, Lynne; Owor, Maxensia; Fiscus, Susan A.; Stranix‐Chibanda, Lynda; Coutsoudis, Anna; Gnanashanmugam, Devasena; Chakhtoura, Nahida; McCarthy, Katie; Mukuzunga, Cornelius; Makanani, Bonus; Moodley, Dhayendre; Nematadzira, Teacler; Kusakara, Bangini.; Patil, Sandesh; Vhembo, Tichaona; Bobat, Raziya; Mmbaga, Blandina T.; Masenya, Maysseb; Nyati, Mandisa; Theron, Gerhard; Mulenga, Helen B.; Butler, Kevin; Shapiro, David E.

doi:10.1097/qai.0000000000001612

Cited by 147 publications

(122 citation statements)

References 25 publications

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“…Results from the PROMISE trial suggest that the risk of HIV transmission through breastfeeding is lower than previously demonstrated . All data for this study came from women and children living in sub‐Saharan Africa and India .…”

Section: Reasons For Supporting Women Living With Hiv In the Uk Who Wmentioning

confidence: 96%

“…It is safe, accessible and commonly done among mothers in the UK [29]. Until we have replicated data to prove otherwise, we can assume that breastfeeding for 12 months on ART presents the child of a mother living with HIV with ã 1% risk of developing an incurable and life-limiting infection [10]. While the predicted life expectancy for adults diagnosed with HIV infection and on effective ART is now the same as for the HIV-negative population [30], children diagnosed with HIV infection continue to experience higher comorbidity and mortality from infections even when treated with ART [31].…”

Section: Potential Harms To the Childmentioning

confidence: 99%

“…2 100% adherence to ART drugs [16,17]. 3 Stop all breastfeeding as early as possible [10,15,47]. 4 Breast milk onlyno other food or drink (apart from vitamins and medications as advised) for the baby [13].…”

Section: The Futurementioning

confidence: 99%

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Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

Freeman-Romilly

Nyatsanza

Namiba³

et al. 2019

HIV Medicine

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Section: Reasons For Supporting Women Living With Hiv In the Uk Who Wmentioning

confidence: 96%

Section: Potential Harms To the Childmentioning

confidence: 99%

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Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

Freeman-Romilly

Nyatsanza

Namiba³

et al. 2019

HIV Medicine

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“…Evidenciando isso, fica claro que a não amamentação é mais um desafio para as gestantes com HIV, uma vez que, para todas elas, é vista como um ato de afeto e carinho, e a partir do momento em que não podem dar para seus filhos acaba gerando sofrimento, o que não pode ser negligenciado pela equipe de saúde que a atende 17,21 . Futuramente, entretanto, esse pode não ser mais um entrave para mães soropositivas que preencham três critérios: carga viral estável com menos de 50 cópias durante a gravidez e a amamentação (1), estar fazendo uso de terapia antirretroviral combinada (2) e estar em acompanhamento médico regular (3) 22,23 . Estudos recentes demonstram tendência de que seja aberta a possibilidade às mães soropositivas de optarem, ou não, por amamentar pelo menos até 1 ano de idade, expondo os riscos e os benefícios para uma decisão compartilhada 22,23 , ao contrário do prezado pelas Diretrizes brasileiras de 2018 que mantiveram a contraindicação absoluta do aleitamento materno 6 .…”

Section: Planejamento Materno E Expectativas Em Relação Ao Futuro Do unclassified

Análise qualitativa dos sentimentos e conhecimentos acerca da gestação e do HIV em gestantes soropositivas e soronegativas

et al. 2018

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Introdução: com a ocorrência da chamada feminização do HIV, tornou-se comum mulheres descobrirem a infecção pelo vírus do HIV no pré-natal em virtude do rastreamento. Entender como tal grupo de gestantes lida com o processo de gestação e de maternidade em relação a grupos de outros fatores de risco é pertinente. Objetivo: realizar uma análise epidemiológica, da percepção e expectativa das gestantes portadoras do HIV em relação ao filho, de questões relacionadas ao autocuidado antes e durante a gestação, comparando com gestantes que apresentam gestação de alto risco, mas soronegativas. Método: foi realizado um estudo qualitativo que entrevistou aleatoriamente 22 gestantes, 10 soropositivas e 12 soronegativas e questionou sobre suas perspectivas em relação à gestação; além da avalição do perfil epidemiológico dessa população. Resultados: as gestantes apresentam um perfil epidemiológico similar ao âmbito nacional. Ambos os grupos apresentam sentimentos comuns em relação ao processo gestacional, parto, e conhecimento sobre transmissão vertical. Entretanto, gestantes soropositivas passam por algumas dificuldades, tanto emocionais, quanto sociais, e preocupações diferentes de gestantes soronegativas. O fato de estar presente a infecção pelo vírus do HIV, durante a gestação, trouxe uma série de temores, como a da transmissão vertical, malformações, julgamento social de estar perpetuando a doença, além da impossibilidade de amamentar. Em contraponto, foi possível perceber que todos esses conflitos que, em um primeiro momento, são desesperadores, podem se tornar motivos de superação, de maior cuidado com a saúde e maior planejamento, se as mães infectadas pelo vírus do HIV tiverem o acompanhamento correto. Conclusão: é essencial a existência de uma equipe multidisciplinar preparada para lidar com os conflitos das gestantes, além de educá-las quanto às formas de transmissão vertical. Em especial no grupo soropositivo, o apoio psicológico quanto ao medo de transmissão vertical e ao processo de confrontar o fato de não poder amamentar faz necessário, pois isso estabelece uma confiança mútua, tanto da paciente em relação a equipe de saúde, quanto da equipe em relação à paciente, algo que é central para a saúde da mãe e do bebê.

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“…KEYWORDS ADCC, HIV-1, antibodies, antiretroviral therapy, breast milk, postnatal transmission W ith optimal maternal antiretroviral therapy (ART) and infant prophylaxis, the rate of human immunodeficiency virus type 1 (HIV-1) transmission through breastfeeding has been significantly reduced, to less than 5% (1)(2)(3)(4)(5). However, several factors contribute to continued infant exposure to HIV during breastfeeding and thus a risk of vertical transmission, including nonadherence to ART, acute maternal infections, and loss to care, primarily in resource-limited areas (6).…”

mentioning

confidence: 99%

Maternal Humoral Immune Responses Do Not Predict Postnatal HIV-1 Transmission Risk in Antiretroviral-Treated Mothers from the IMPAACT PROMISE Study

Hompe

Jacobson

Eudailey

et al. 2019

mSphere

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To design immune interventions that can synergize with antiretroviral therapy (ART) to reduce the rate of HIV mother-to-child transmission (MTCT), it is essential to characterize maternal immune responses in the setting of ART during pregnancy and breastfeeding and define their effect on MTCT. Prior studies reported an association between breast milk envelope (Env)-specific antibodies and antibody-dependent cell cytotoxicity (ADCC) activity with reduced postnatal transmission. In this study, we investigated whether these immune correlates were similarly associated with protection in a matched case-control study of mother-infant pairs receiving maternal ART or infant nevirapine prophylaxis during breastfeeding in the International Maternal-Pediatric-Adolescent AIDS Clinical Trials Network Promoting Maternal-Infant Survival Everywhere (PROMISE) trial, assessing postnatal transmission risk in 19 transmitting and 57 nontransmitting mothers using conditional logistic regression models adjusted for maternal plasma viral load. The odds ratios of postnatal MTCT for a 1-unit increase in an immune correlate were 3.61 (95% confidence interval [CI], 0.56, 23.14) for breast milk Env-specific secretory IgA (sIgA), 2.32 (95% CI, 0.43, 12.56) for breast milk and 2.16 (95% CI, 0.51, 9.14) for plasma Env-specific IgA, and 4.57 (95% CI, 0.68, 30.48) for breast milk and 0.96 (95% CI, 0.25, 3.67) for plasma ADCC activity, with all CIs spanning 1.0. Interestingly, although mucosal IgA responses are poor in untreated HIV-infected women, there was a strong correlation between the magnitudes of breast milk and plasma Env-specific IgA in this cohort. In this analysis of the small number of postnatal virus transmissions in the landmark PROMISE study, no single antibody response was associated with breast milk transmission risk. IMPORTANCE Each year, >150,000 infants become newly infected with HIV-1 through MTCT despite ART, with up to 42% of infections occurring during breastfeeding. Several factors contribute to continued pediatric infections, including ART nonadherence, the emergence of drug-resistant HIV strains, acute infection during breastfeeding, and poor access to ART in resource-limited areas. A better understanding of the maternal humoral immune responses that provide protection against postnatal transmission in the setting of ART is critical to guide the design of maternal vaccine strategies to further eliminate postnatal HIV transmission. In this study, we found that in women treated with antiretrovirals during pregnancy, there was a positive correlation between plasma viral load and breast milk and plasma IgA responses; however, conclusions regarding odds of MTCT risk were limited by the small sample size. These findings will inform future studies to investigate maternal immune interventions that can synergize with ART to eliminate MTCT during breastfeeding.

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Prevention of HIV-1 Transmission Through Breastfeeding: Efficacy and Safety of Maternal Antiretroviral Therapy Versus Infant Nevirapine Prophylaxis for Duration of Breastfeeding in HIV-1-Infected Women With High CD4 Cell Count (IMPAACT PROMISE): A Randomized, Open-Label, Clinical Trial

Abstract: Both mART and iNVP prophylaxis strategies were safe and associated with very low breastfeeding HIV-1 transmission and high infant HIV-1-free survival at 24 months.

Cited by 147 publications

References 25 publications

Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

Moving closer to what women want? A review of breastfeeding and women living with HIV in the UK and high‐income countries

Análise qualitativa dos sentimentos e conhecimentos acerca da gestação e do HIV em gestantes soropositivas e soronegativas

Maternal Humoral Immune Responses Do Not Predict Postnatal HIV-1 Transmission Risk in Antiretroviral-Treated Mothers from the IMPAACT PROMISE Study

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