Cover Image
close this bookPost-Durban Update on ARVs for MTCT-prevention (UNAIDS, 2000, 8 p.)
View the document(introduction...)
View the documentShort term efficacy (6 weeks to 3 months)
View the documentLong-term efficacy (12 to 24 months)
View the documentARV and transmission through breast feeding
View the documentDrug resistance with Nevirapine
View the documentConclusion
View the documentReferences

Long-term efficacy (12 to 24 months)

Three studies provided information on whether the short-term benefits of the different ARV regimens is maintained in infants exposed to HIV through breastfeeding (Table 3). The pooled analysis from the West African studies showed that the difference in transmission rates at 3 months was still present up to 24 months.12 Similarly for the HIVNET012 study up to 12 months follow-up.13 By contrast the PETRA study reported that the differences seen in HIV-free survival between study arms at 6 weeks had decreased by 18 months.5 However, it is unclear whether this diminution of the difference is due to increased HIV transmission or to non-HIV-related mortality. The PETRA Study team announced that further information on the exact timing of transmission through breastfeeding from their trial will be available in September 2000.

Table 3: Long term follow-up in breast feeding populations

Trial

Ref

Intervention

Early transmission

Late transmission




Age

Rate

Difference

Efficacya

Age

Rate (%)

Difference

Efficacya

West African pooled analysis

12

ZDV from 36 w

3m

16%

9%

35%

24m

22%

8%

28%



Placebo

3m

25%



24m

30%



HIVNET012

13

NVP

6-8 w

12%

8%

41%

12m

16%

8%

35%



ZDV Intrapartum

6-8 w

20%



12m

24%



PETRAb












Arm A

5

From 36w + 1w pp

6 w

8%

11%

57%

18m

21%

6%

21%


Arm B


In labour + 1 w pp

6 w

12%

7%

36%

18m

25%

2%

7%


Arm C


In labour only

6 w

19%

0%

2%

18m

28%

-1%

-4%


Placebo



6 w

19%



18m

27%



Note

a Prevented fraction (1 - rate in active group/rate in comparison group)
b Endpoint: HIV transmission and mortality (= 1- HIV-free survival)

References (numbers according to final reference list)

12 Wiktor, Durban TuOrB354
5 Gray, Durban LbOr5
13 Owor, Durban LbOr1