HIV positive Moms: early weaning risky for babies

Weaning before a baby is 6 months old is a bad idea for HIV-positive mothers in circumstances where breastfeeding has no safe alternative, researchers reported. And treatment with anti-retroviral drugs should continue as long as breastfeeding is required, according to Charles van der Horst, MD, of the University of North Carolina, in Chapel Hill, N.C., and colleagues. The finding comes from 48-week follow-up of a large randomized trial that compared different treatment strategies for six months, and then encouraged weaning without further therapy, van der Horst and colleagues reported online in The Lancet. The researchers reported in 2010 that treatment of either the mother or infant during the first six months of breastfeeding reduced the risk of HIV transmission, compared with no therapy. In the current analysis, they looked at what happened when the babies were weaned at 6 months and treatment was stopped. The bottom line, van der Horst told MedPage Today, is that "weaning puts the baby at risk for ... other infections," such as pneumonia and tuberculosis. At the same time, he added, it's important to continue therapy as long as the baby is being breastfed in order to continue to prevent HIV transmission. In the so-called BAN study - for Breastfeeding, Antiretrovirals, and Nutrition - 2,369 mother-and-infant pairs in which the mother was HIV-positive got the now-standard perinatal prophylaxis of a single dose of nevirapine (Viramune) and a week of nevirapine and lamivudine (3TC). All of the mothers had a CD4-positive lymphocyte count of at least 250 cells per cubic millimeter and thus, by then-current standards, did not require anti-retroviral therapy for their own health. After the first week, they were randomly assigned to no further treatment (the control group), to maternal therapy with a triple-drug regimen, or to infant treatment with nevirapine. Between 24 and 28 weeks, van der Horst said, the mothers were asked to stop breastfeeding, but were supported with additional care to ensure the infants had adequate nutrition. Despite that, the researchers found, the rate of serious adverse events in infants was markedly higher during weeks 29 through 48 than during the intervention phase. Specifically, during the intervention phase, the overall rate of adverse events among the babies was 0.7 per 100 person weeks, which jumped significantly (at P