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AIDS Threat From Breastfeeding Declines With Treatment in Study

AIDS transmission to babies was blocked in 99 percent of cases when breastfeeding mothers infected with the HIV virus took triple-drug combinations, according to a Harvard University study released today.

Virus transmission fell to 1.1 percent when mothers were assigned to one of three combination regimens initiated before birth and continued through six months of pregnancy, according to the study conducted in Botswana and published in the New England Journal of Medicine. Without the drugs, the infection rate would be at least 25 percent, the study’s authors reported.

About 430,000 children worldwide are infected with HIV each year, and more than 90 percent of such infections occur in sub-Saharan Africa, a region where breast-feeding is especially important for infant survival, according to a separate editorial in the journal. The study’s three drug regimens, made by GlaxoSmithKline Plc, Abbott Laboratories and Boehringer Ingelheim GmbH, were found similarly effective.

“Until now, HIV-infected mothers in Africa were faced with a choice between breastfeeding and a high risk of infecting their children with HIV, or using formula and risking high infant morbidity and mortality,” said Max Essex, senior author of the study and chair of the AIDS Initiative at the Harvard School of Public Health in Boston, in an e-mailed statement. “This study provides a more tolerable solution.”

The research was conducted by the Harvard School of Public Health and the government of Botswana. It was funded in part by U.S. grants.

Malawi Study

A separate study in the journal today, conducted in Malawi, found benefits in giving antiretroviral drugs to either the mother or infant during breastfeeding. The Malawi study compared the six-month treatments with a one-week regimen initiated just before birth. The one-week program was significantly less effective, even among mothers who didn’t need medicine for their own health because their virus levels were low.

Influenced by early results from the Botswana study, the World Health Organization now recommends that mothers or infants receive antiretroviral treatment throughout breastfeeding, according to the Harvard statement. Botswana is planning a new program to provide combination therapies to all pregnant women with HIV, the researchers said.

Glaxo is based in London; Boehringer is a closely held company based in Ingelheim, Germany; and Abbott is based in Abbott Park, Illinois.

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