This was revealed by Dr Roger Shapiro of the Botswana-Havard AIDS Institute when releasing the findings of a random trial comparing HAART regimens for virologic efficacy and the prevention of mother-to-child HIV transmission among breastfeeding mothers in Botswana at Boipuso Hall in Gaborone last Friday.
The Mmabana Study, as the programme is called, also revealed that Maternal Highly Active Antiretroviral Therapy (HAART) from early in the third trimester of pregnancy through six months of breastfeeding is a safe and effective strategy for preventing mother-to-child-transmission of HIV/AIDS while allowing for the benefits of breastfeeding.
Dr Shapiro explained that among a sample of 730 HIV-infected pregnant women in Botswana, starting HAART early in the third trimester of pregnancy led to 95 percent viral suppression at delivery and 93 percent throughout breastfeeding. He said similar rates of viral suppression were observed among 560 women randomized to receive either trizivir or Kaletra/ Combivir, and among 170 women who observationally received nevarapine/ Combivir.
Dr Shapiro, who was also the team leader in the study, said among the 709 live born infants, the overall MTCT rate was one percent through six months. "Only two transmissions occurred during breastfeeding," he said, adding that this is the lowest MTCT rate ever recorded in Africa or for a breastfeeding population.
The Mmabana Study was conducted at four clinical sites in Botswana, as a collaboration between the Botswana Government and Havard School of Public Health.
The primary objective of the study was to compare the suppression of HIV viral load to less than 400 copies per milliliter at delivery and throughout breastfeeding among women randomized to receive HAART regimens, and to determine the MTCT rate after six months of breastfeeding among all women who received HAART.
The women initiated HAART at between 26 and 34 weeks of gestation in the observational arm. "Women were instructed to exclusively breastfeed and to wean their infants from breast milk at six months of age," Doctor Shapiro said, adding that the HAART used appeared to be safe and well tolerated.
The women received counseling from trained professionals who were also nurses. They educated the women on the dangers of mixing breast milk with formula and checked if the mothers were really breastfeeding by doing a through breast exam.
"That was to check if the breast produced milk and if there were no cracks or sores on the breast that could put the baby in danger of being infected," one of the nurses on the counseling team said. "We made it an environment where the mothers felt safe in confiding (in us) what problems they might have been encountering or whether they have mix-fed the infants."
The Mmabana Study is one in a series of PMTCT programmes that the Botswana-Havard Partnership is currently undertaking.