Featured Research

from universities, journals, and other organizations

Prevention of mother-child transmission programs work but infants need checking for drug resistance, study suggests

Date:
March 29, 2011
Source:
Public Library of Science
Summary:
Genetic mutations that lead to antiretroviral (the drugs used to treat HIV/AIDS) resistance in HIV-infected infants may develop as a result of exposure to low doses of maternal antiretroviral drugs via breastfeeding rather than being acquired directly from the mother.

Genetic mutations that lead to antiretroviral (the drugs used to treat HIV/AIDS) resistance in HIV-infected infants may develop as a result of exposure to low doses of maternal antiretroviral drugs via breastfeeding rather than being acquired directly from the mother. This key finding from a study by Clement Zeh from the US Centers for Disease Control and Prevention, Kisumu, Kenya, and colleagues, published in this week's PLoS Medicine, is important as it may impact the choice of drug regimen given to HIV-infected breastfeeding mothers and their infected infants -- an effective intervention which has been shown to substantially reduce the overall rate of mother-to-child transmission of the HIV virus.

Related Articles


The authors conducted a secondary analysis (or substudy) of The Kisumu Breastfeeding Study -- a trial in Kisumu, Kenya by Timothy Thomas and colleagues from the Kenya Medical Research Institute (KEMRI) and CDC, Kisumu, Kenya, and colleagues also reported in this week's PLoS Medicine. The Kisumu Breastfeeding Study assessed the safety and transmission rates of a triple-antiretroviral regimen (zidovudine, lamivudine, and either nevirapine or nelfinavir) given to HIV-infected women a few weeks before giving birth (34 wk gestation) through 6 months of breastfeeding. The study documented transmission rates of 7% at 24 months, most of them due to transmission in-utero or during delivery, which is considerably lower than the 25% -- 48% transmission rates reported in the absence of antiretrovirals. The authors concluded that this combination of drugs was safe and feasible in resource-limited settings.

In their secondary analysis, Clement Zeh and colleagues investigated the possible causes of the emergence of maternal ARV-associated resistance among the 24 infants who were infected with HIV either at delivery or during 6 months of breastfeeding and thus exposed to maternal ARVs.

The authors took regular blood samples from these infants and from their mothers to look for the presence of HIV drug resistance mutations. The authors found that various mutations were present in samples taken from all the HIV-positive infants whose mothers who had received nelfinavir but in only half of those taken from infants whose mothers who had received nevirapine. However exposure to nevirapine resulted in a wider range of ARV resistant mutations. In contrast, most of the mothers of HIV-positive infants had no HIV drug resistance mutations, and only one mother-infant pair had an overlapping pattern of HIV drug resistance mutations. This pattern of mutations suggests that drug resistance most likely arose through exposure of the infants to low levels of ARVs in breast milk rather than through mother-to-child transmission of drug-resistant HIV virus.

These findings need further confirmation through future studies but suggest that infants exposed to antiretroviral drugs through breast milk -- a situation that may become increasingly common given the encouraging results of The Kisumu Breastfeeding Study and similar trials that show a reduction in mother-to-child-transmission -- should be carefully monitored for HIV infection. Providers should consider the mother's regimen when choosing treatment for infants who are found to be HIV infected while breastfeeding and closely monitor response to therapy.

Clement Zeh and colleagues say: "The low mother-to-child HIV transmission rates observed in the trial support the role of triple-combination maternal antiretroviral therapy as a successful [Prevention of Mother-to-Child Transmission] intervention among breastfeeding HIV-infected mothers. However, the data from this secondary analysis suggest that ingestion of antiretroviral drugs through breast milk may have contributed to the emergence of HIV drug resistance mutations in the infants, as we observed an increasing frequency of infants with HIV drug resistance mutations over the first 6 months of life when maternal antiretroviral therapy was given during breastfeeding."

They add: "[Prevention of Mother-to-Child Transmission] programs providing maternal antiretroviral therapy during breastfeeding and those caring for infants exposed to antiretroviral through breast milk will need to be cognizant of this issue and consider monitoring these infants more closely and tailoring their treatment accordingly."


Story Source:

The above story is based on materials provided by Public Library of Science. Note: Materials may be edited for content and length.


Journal References:

  1. Clement Zeh, Paul J. Weidle, Lillian Nafisa, Humphrey M. Lwamba, Jully Okonji, Emily Anyango, Philip Bondo, Rose Masaba, Mary Glenn Fowler, John N. Nkengasong, Michael C. Thigpen, Timothy Thomas. HIV-1 Drug Resistance Emergence among Breastfeeding Infants Born to HIV-Infected Mothers during a Single-Arm Trial of Triple-Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission: A Secondary Analysis. PLoS Medicine, 2011; 8 (3): e1000430 DOI: 10.1371/journal.pmed.1000430
  2. Timothy K. Thomas, Rose Masaba, Craig B. Borkowf, Richard Ndivo, Clement Zeh, Ambrose Misore, Juliana Otieno, Denise Jamieson, Michael C. Thigpen, Marc Bulterys, Laurence Slutsker, Kevin M. De Cock, Pauli N. Amornkul, Alan E. Greenberg, Mary Glenn Fowler. Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial. PLoS Medicine, 2011; 8 (3): e1001015 DOI: 10.1371/journal.pmed.1001015

Cite This Page:

Public Library of Science. "Prevention of mother-child transmission programs work but infants need checking for drug resistance, study suggests." ScienceDaily. ScienceDaily, 29 March 2011. <www.sciencedaily.com/releases/2011/03/110329172245.htm>.
Public Library of Science. (2011, March 29). Prevention of mother-child transmission programs work but infants need checking for drug resistance, study suggests. ScienceDaily. Retrieved October 25, 2014 from www.sciencedaily.com/releases/2011/03/110329172245.htm
Public Library of Science. "Prevention of mother-child transmission programs work but infants need checking for drug resistance, study suggests." ScienceDaily. www.sciencedaily.com/releases/2011/03/110329172245.htm (accessed October 25, 2014).

Share This



More Health & Medicine News

Saturday, October 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

IKEA Desk Converts From Standing to Sitting With One Button

IKEA Desk Converts From Standing to Sitting With One Button

Buzz60 (Oct. 24, 2014) IKEA is out with a new convertible desk that can convert from a sitting desk to a standing one with just the push of a button. Jen Markham explains. Video provided by Buzz60
Powered by NewsLook.com
Ebola Protective Suits Being Made in China

Ebola Protective Suits Being Made in China

AFP (Oct. 24, 2014) A factory in China is busy making Ebola protective suits for healthcare workers and others fighting the spread of the virus. Duration: 00:38 Video provided by AFP
Powered by NewsLook.com
WHO: Millions of Ebola Vaccine Doses by 2015

WHO: Millions of Ebola Vaccine Doses by 2015

AP (Oct. 24, 2014) The World Health Organization said on Friday that millions of doses of two experimental Ebola vaccines could be ready for use in 2015 and five more experimental vaccines would start being tested in March. (Oct. 24) Video provided by AP
Powered by NewsLook.com
Doctor in NYC Quarantined With Ebola

Doctor in NYC Quarantined With Ebola

AP (Oct. 24, 2014) An emergency room doctor who recently returned to the city after treating Ebola patients in West Africa has tested positive for the virus. He's quarantined in a hospital. (Oct. 24) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins