Original Article
Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission
N Engl J Med 2008; 359:119-129July 10, 2008
- Abstract
Background
Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings.
Methods
Women with HIV-1 infection who were breast-feeding infants were enrolled in a randomized, phase 3 trial in Blantyre, Malawi. At birth, the infants were randomly assigned to one of three regimens: single-dose nevirapine plus 1 week of zidovudine (control regimen) or the control regimen plus daily extended prophylaxis either with nevirapine (extended nevirapine) or with nevirapine plus zidovudine (extended dual prophylaxis) until the age of 14 weeks. Using Kaplan–Meier analyses, we assessed the risk of HIV-1 infection among infants who were HIV-1–negative on DNA polymerase-chain-reaction assay at birth.
Results
Among 3016 infants in the study, the control group had consistently higher rates of HIV-1 infection from the age of 6 weeks through 18 months. At 9 months, the estimated rate of HIV-1 infection (the primary end point) was 10.6% in the control group, as compared with 5.2% in the extended-nevirapine group (P<0.001) and 6.4% in the extended-dual-prophylaxis group (P=0.002). There were no significant differences between the two extended-prophylaxis groups. The frequency of breast-feeding did not differ significantly among the study groups. Infants receiving extended dual prophylaxis had a significant increase in the number of adverse events (primarily neutropenia) that were deemed to be possibly related to a study drug.
Conclusions
Extended prophylaxis with nevirapine or with nevirapine and zidovudine for the first 14 weeks of life significantly reduced postnatal HIV-1 infection in 9-month-old infants. (ClinicalTrials.gov number, NCT00115648.)
Media in This Article
Figure 1
Enrollment and Outcomes, 2004–2007.Figure 2
Kaplan–Meier Estimates of the Rates of HIV-1 Infection, Death, and a Composite of HIV-1 Infection or Death among Infants during Their First 24 Months.Article Activity
- Article
In sub-Saharan Africa, where breast-feeding is critical for infant survival, postnatal transmission of human immunodeficiency virus type 1 (HIV-1) occurs in up to 16% of untreated infants when breast-feeding continues into the second year of life.1 Although effective interventions have been identified to reduce in utero and intrapartum transmission of HIV-1 in resource-limited countries,2 breast-feeding attenuates the efficacy of such methods.3,4 Thus, a major concern in developing countries is HIV-1 transmission through breast milk.5 To optimize the survival of infants who are born to mothers with HIV-1 infection, interventions that allow safe breast-feeding during the first 6 months of life or longer are needed.
The aim of our trial, called the Post-Exposure Prophylaxis of Infants (PEPI) trial, was to determine whether extended prophylaxis of infants with nevirapine or with nevirapine plus zidovudine until the age of 14 weeks (when the infant immunization schedule is completed in Malawi) would decrease the rate of HIV-1 infection, as compared with single-dose nevirapine combined with 1 week of zidovudine (control regimen). The control regimen, which was previously shown to be effective in a randomized trial in Malawi, is recommended in resource-limited settings, including Malawi.6-8
Methods
Study Population
Pregnant women who presented for either antenatal or delivery services at Queen Elizabeth Central Hospital or at one of five other health centers in Blantyre, Malawi, were offered HIV-1 counseling and testing. All women with HIV-1 infection, except those whose HIV-1 infection was not identified until after they gave birth (late presenters), received intrapartum single-dose nevirapine. Women could be enrolled in the trial if they had HIV-1 infection, were at least 18 years of age (although women <18 years of age could be enrolled if they consented and a guardian gave permission), were pregnant or had given birth within the previous 24 hours at one of the study clinics, were a resident of the study area, were willing to return for postnatal follow-up visits for up to 2 years, and intended to breast-feed. Infants with life-threatening conditions requiring immediate care were excluded. All eligible women provided written informed consent at enrollment.
The protocol and study consent forms were approved by institutional review boards at the University of Malawi, Johns Hopkins University, and the Centers for Disease Control and Prevention. Enrollment began on April 20, 2004. The current analysis includes data on women and their infants who were enrolled in the study through August 7, 2007. All authors vouch for the completeness and accuracy of the data presented.
Study Design
In our randomized, controlled, open-label, phase 3 clinical trial, infants were randomly assigned at birth to receive one of three regimens: single-dose nevirapine combined with 1 week of daily zidovudine (control group) or the control regimen followed by extended daily prophylaxis with either oral nevirapine (extended-nevirapine group) or oral nevirapine plus zidovudine (extended-dual-prophylaxis group) until the age of 14 weeks. Women were counseled at each visit to breast-feed exclusively for 6 months and to consider weaning thereafter.
Study-Drug Regimens
Beginning immediately after birth, all infants received a single oral dose of nevirapine (2 mg per kilogram of body weight) plus oral zidovudine (4 mg per kilogram), given twice daily for 1 week. Zidovudine was given for 1 week rather than 4 weeks for the following reasons: the 1-week regimen was shown to be more effective than single-dose nevirapine alone in a randomized trial in Malawi6,7 and is the recommended regimen for infants born to women who have not received antenatal antiretroviral prophylaxis in Malawi; no clinical trials have shown that a 4-week regimen is superior to a 1-week regimen when single-dose nevirapine is also given; and in a study in South Africa,9 a 6-week regimen of zidovudine provided no better protection than single-dose nevirapine alone.
Drugs for infants in the two extended-prophylaxis groups were dispensed to the mothers starting at the 1-week study visit and at subsequent visits until the infant completed the 14-week regimen. In the extended-prophylaxis groups, the oral dose of nevirapine was 2 mg per kilogram once daily during week 2, then 4 mg per kilogram once daily during weeks 3 through 14. The oral dose of zidovudine was 4 mg per kilogram twice daily during weeks 2 through 5, 4 mg per kilogram three times daily during weeks 6 through 8, and 6 mg per kilogram three times daily during weeks 9 through 14.
Prophylaxis regimens were discontinued for infants in the extended-prophylaxis groups who were found to have HIV-1 infection during the first 14 weeks of life. However, these infants were still followed for the duration of the study.
Study Follow-up and Procedures
Study visits were conducted at 1, 3, 6, 9, and 14 weeks and at 6, 9, 12, 15, 18, and 24 months of infant age. Infant blood samples were collected by heel-stick or venous puncture for HIV-1 testing and dried-blood spot storage at each visit except week 3. Specimens for a complete blood count and testing of alanine aminotransferase levels were collected at each visit through 6 months; plasma was collected at birth, at 6 and 14 weeks, and at 6, 12, and 18 or 24 months.
All women in the study and any of their infants who were found to have HIV-1 infection were referred for antiretroviral therapy at clinics at a study health center, although the availability of antiretroviral treatment in Malawi was limited, with increased availability only late in the study. Only small percentages of women (2.6% in the control group, 2.8% in the extended-nevirapine group, and 3.2% in the extended-dual-prophylaxis group) received antiretroviral therapy before 14 weeks post partum (P=0.77 for all comparisons). The maternal rates of antiretroviral therapy were slightly higher after the 14-week study period (11.8% in the control group, 12.2% in the extended-nevirapine group, and 11.4% in the extended-dual-prophylaxis group) (P=0.87 for all comparisons). All infants who were exposed to or infected with HIV-1 received prophylaxis with trimethoprim–sulfamethoxazole to prevent pneumocystis pneumonia. Further details regarding the monitoring and randomization of patients and the collection of data are available in the Supplementary Appendix, available with the full text of this article at www.nejm.org.
Study End Points
The primary study end point was the rate of HIV-1 infection by the age of 9 months among live-born infants who were negative for HIV-1 infection on DNA polymerase-chain-reaction (PCR) assay at birth (i.e., within the first 48 hours). Infants were evaluated for the presence of HIV-1 infection at 6, 9, and 14 weeks and at 6, 12, 18, and 24 months. Additional primary end points were survival free of HIV-1 infection during follow-up and the safety of the experimental regimens.
The presence or absence of HIV-1 infection was determined by Roche Amplicor 1.5 DNA PCR (Roche Molecular Systems). Positive specimens were confirmed by testing a second specimen obtained as soon as possible after an initial positive test. Specimens with discrepant test results at the local laboratory were retested in a reference laboratory at the University of North Carolina, Chapel Hill. Final infection status was determined by three investigators who were unaware of infants' study-group assignments. For infants whose infection status was not resolved by retesting at the reference laboratory (e.g., because no sample was available for repeat testing), those with a positive test result that was followed by multiple negative tests (either on DNA PCR or on HIV-antibody enzyme immunoassays) were considered to be uninfected. All other infants whose HIV-1 status still could not be resolved (e.g., owing to termination from the study because of relocation or removal from the study by a parent) were excluded from the analysis, including 14 infants in the control group, 5 in the extended-nevirapine group, and 15 in the extended-dual-prophylaxis group.
Diagnosis of HIV-1 infection was based on a positive HIV-1 DNA PCR assay at any visit or a positive enzyme-linked immunosorbent assay (ELISA) and Western blot analysis at the age of 15 months or later. An infant with at least two positive HIV-1 test results on separate visits was classified as having confirmed HIV-1 infection, and an infant with only a single positive result (due to the death of the infant, loss to follow-up, or a pending confirmatory test) was classified as having presumptive HIV-1 infection. All identified adverse events were documented and graded with the use of a toxicity table adopted in April 1994 by the Division of AIDS at the National Institutes of Health.
Statistical Analysis
We present all data that were obtained through the cutoff date for the second interim analysis (August 7, 2007). Study groups were examined for similarity according to baseline covariates (continuous or categorical) with the use of the t-test, analysis of variance, Fisher's exact test, and the chi-square test.
In an intention-to-treat analysis, we compared each extended-prophylaxis group with the control group. We used Kaplan–Meier analyses to estimate the time until the first positive HIV-1 test (either confirmed or presumptive, with data for infants without a positive HIV-1 test censored at the time of death), the time to death, and the time to either death or the first positive HIV-1 test (whichever came first), according to study group. Cox proportional-hazards models of the time until the first positive HIV-1 test, with adjustment for study group and other covariates that were considered to have biologic or epidemiological importance, were performed with SAS software, version 9.1 (SAS Institute).
The study was designed to enroll 3500 infants to include at least 3000 who were not infected with HIV-1 at birth on the basis of an assumed rate of infection of 8% and an assumed rate of postpartum transmission of 14% at 9 months in the control group. The data and safety monitoring board recommended that enrollment in the study be stopped at the second interim analysis (December 10, 2007), since the P value for the difference between the extended-nevirapine group and the control group exceeded a Bonferroni-adjusted O'Brien–Fleming rejection threshold (alpha level, 0.0063). At this time, 3016 infants who were not infected with HIV-1 at birth were enrolled in the study. A total of 2522 infants either with HIV-1 infection or without HIV-1 infection were enrolled for at least 9 months.
Results
Patients
A total of 46,186 women underwent screening for HIV-1 infection. Women with HIV-1 infection who met the inclusion criteria and signed an informed consent form were enrolled in the study. Of 3276 infants who were enrolled and underwent randomization at birth, 260 were excluded from the efficacy analysis: 226 because they were found to have HIV-1 infection and 34 because their HIV-1 status at birth was not known. These exclusions were distributed equally among the three study groups. Therefore, 3016 infants were included in the primary analysis (Figure 1Figure 1
Enrollment and Outcomes, 2004–2007.).Baseline demographic and laboratory characteristics of the women and their infants were similar in the three study groups (Table 1Table 1
Baseline Characteristics of Mothers and Infants.). All infants received a single dose of nevirapine at birth, and of the 2427 infants who returned for the first-week visit, 99% received zidovudine. At 14 weeks, adherence (defined as the proportion of infants who received treatment among those who returned for the visit) was 97.3% (658 of 676 infants) in the extended-nevirapine group and 97.8% (673 of 688 infants) in the extended-dual-prophylaxis group (P=0.60).Frequency of Breast-Feeding
The frequency of reported breast-feeding was high up to the age of 6 months, ranging from nearly all infants at 1 week to approximately 90% at 6 months in all three study groups. Between the ages of 6 and 9 months, there was a substantial reduction in the frequency of breast-feeding in all three groups, with rates at 9 months of 32.0% in the control group, 26.9% in the extended-nevirapine group, and 29.2% in the extended-dual-prophylaxis group (P=0.16 for all comparisons). By the age of 15 months, the rate of breast-feeding had declined to 19.4% in the control group, 14.4% in the extended-nevirapine group, and 18.1% in the extended-dual-prophylaxis group (Table 2Table 2
Frequency of Breast-Feeding, According to Study Visit.).HIV-1 Infection
Of the 3016 infants, 255 were found to have HIV-1 infection by August 7, 2007. Of these cases, 242 were confirmed and 13 were presumptive; the frequency of HIV infections that were classified as presumptive was similar in the three study groups (P=0.22 for all comparisons). Both confirmed and presumptive HIV-1 infections were included in the primary analysis, although limiting the analysis to only confirmed HIV-1 infections produced similar results (data not shown). The rates of HIV-1 positivity on DNA analysis at birth were 6.5% in the control group and 7.1% in both extended-prophylaxis groups (P=0.85 for all comparisons). Before the primary end point at 9 months, the numbers of infants who were lost to follow-up without a positive HIV-1 test were 136 in the control group, 131 in the extended-nevirapine group, and 109 in the extended-dual-prophylaxis group.
Among infants who were not infected at birth (i.e., excluding infants with positive DNA PCR tests for HIV), between the ages of 6 weeks and 18 months, the control group had consistently higher rates of HIV-1 infection, as compared with both extended-prophylaxis groups (Figure 2AFigure 2
Kaplan–Meier Estimates of the Rates of HIV-1 Infection, Death, and a Composite of HIV-1 Infection or Death among Infants during Their First 24 Months.). Among 9-month-old infants, the rate of HIV-1 infection, as estimated from Kaplan–Meier curves for which data were censored at the time of loss to follow-up, was 10.6% (95% confidence interval [CI], 8.7 to 12.8) in the control group, 5.2% (95% CI, 3.9 to 7.0) in the extended-nevirapine group (P<0.001 for the comparison with the control group), and 6.4% (95% CI, 4.9 to 8.3) in the extended-dual-prophylaxis group (P=0.002 for the comparison with the control group). The total numbers of infants with positive results on HIV-1 DNA PCR at 9 months were 98 in the control group, 51 in the extended-nevirapine group, and 61 in the extended-dual-prophylaxis group. The estimated protective efficacy10 of the extended-nevirapine regimen was 67% (95% CI, 43 to 81) at 6 weeks, 67% (95% CI, 49 to 79) at 14 weeks, 60% (95% CI, 42 to 73) at 6 months, and 51% (95% CI, 30 to 66) at 9 months. The estimated protective efficacy of the extended-dual-prophylaxis regimen was 69% (95% CI, 45 to 83) at 6 weeks, 66% (95% CI, 48 to 78) at 14 weeks, 49% (95% CI, 27 to 64) at 6 months, and 40% (95% CI, 16 to 57) at 9 months. There were no significant differences between the two extended-prophylaxis groups at any time point.Death
Regardless of HIV-1–infection status, 285 infants died during the study: 106 in the control group, 89 in the extended-nevirapine group, and 90 in the extended-dual-prophylaxis group. Of these infants, those who had already died by the age of 9 months included 71 in the control group, 55 in the extended-nevirapine group, and 51 in the extended-dual-prophylaxis group. Although mortality in the control group exceeded that in the two extended-prophylaxis groups after the age of 6 months, the differences were not significant (Figure 2B). At 9 months, mortality was 8.9% (95% CI, 7.1 to 11.1) in the control group, 6.8% (95% CI, 5.2 to 8.7) in the extended-nevirapine group, and 6.3% (95% CI, 4.8 to 8.2) in the extended-dual-prophylaxis group.
Table 3Table 3
Associated Risk Factors for HIV-1 Infection and for a Composite of HIV-1 Infection or Death. shows the results of the Cox proportional-hazards analyses of risk factors for HIV-1 infection and for either HIV-1 infection or death. In the adjusted analysis, both extended-prophylaxis regimens were significantly associated with a reduced risk of HIV-1 infection; a decrease in the maternal CD4 cell count was associated with an increased risk of infection. Lower infant birth weight was also associated with an increased risk of either HIV-1 infection or death. The primary causes of infant death were gastroenteritis (30% in the control group, 26% in the extended-nevirapine group, and 30% in the extended-dual-prophylaxis group) and pneumonia (26%, 23%, and 21%, respectively). HIV-1–free survival was significantly better in both extended-prophylaxis groups through the age of 9 months and in the extended-nevirapine group through the age of 15 months (Figure 2C).
Serious Adverse Events
Overall, 1283 serious adverse events were reported in 887 infants, with no significant differences among the three study groups for any adverse event (P=0.34 for all comparisons by Fisher's exact test) or for ordered treatment relatedness of adverse events (P=0.14 by the Jonckheere–Terpstra test11) (Table 4Table 4
Serious Adverse Events.). The most frequent serious adverse events in all three groups were respiratory (329 events), gastrointestinal (227 events), and hematologic (191 events), and the rates were similar in all three study groups (Table 2 in the Supplementary Appendix). Overall, most serious adverse events (87.3%) were not significantly associated with a study drug. However, there were significantly more infants with serious adverse events that were deemed to be possibly related to a study drug in the extended-dual-prophylaxis group than in either the extended-nevirapine group or the control group (P=0.02 for all comparisons). The most common serious adverse event in the extended-dual-prophylaxis group was neutropenia. The numbers of events that were deemed to be probably related to a study drug were low and did not differ among the study groups (P=0.42 for all comparisons).Discussion
We evaluated two different extended 14-week post-exposure regimens to reduce postnatal HIV-1 transmission in a large, randomized clinical trial. Our study demonstrated that both extended-prophylaxis regimens significantly reduced the risk of postnatal transmission at 14 weeks with a protective efficacy of more than 60%. The cumulative risk of postnatal infection between birth and 14 weeks was 8.4% in the control group, as compared with approximately 2.8% in the extended-prophylaxis groups. This net difference of approximately 5% between the extended-prophylaxis groups and the control group continued at 24 months.
Although there were no significant differences in overall mortality, the control group had consistently higher mortality after the age of 6 months than did either of the extended-prophylaxis groups, a difference that appeared to be largely due to a higher rate of HIV-1 infection in the control group. There were significant increases in HIV-1–free survival for the infants in both extended-prophylaxis groups at the age of 9 months and for those in the extended-nevirapine group up to the age of 15 months.
The frequency of breast-feeding was high during the first 6 months (approximately 90%). Although most infants were weaned between the ages of 6 and 9 months, more than 20% were still breast-feeding at that time. After discontinuation of extended prophylaxis, the rate of postnatal HIV-1 infection occurring in infants between the ages of 14 weeks and 9 months was similar in the three study groups, with a rate of additional HIV-1 infections of 2.2% in the control group, 2.4% in the extended-nevirapine group, and 3.5% in the extended-dual-prophylaxis group.
The choice of providing daily prophylaxis up to 14 weeks was based on the recommended infant immunization schedule in Malawi, which is completed at 14 weeks. Most infants do not return to the clinic until the age of 9 months to receive measles immunization. Therefore, from a public health point of view, an approach to HIV-1 prophylaxis that is integrated into the typical infant immunization schedule would facilitate implementation in resource-constrained settings. There were no significant differences in efficacy between the two extended-prophylaxis groups. However, serious adverse events (primarily neutropenia) that were possibly related to a study drug were more frequent in the extended-dual-prophylaxis group. Whether the two-drug regimen would reduce the risk of resistance to nevirapine among infants who become infected with HIV-1 despite extended prophylaxis is being investigated.
Another approach to the prevention of postnatal transmission of HIV-1 is the treatment of mothers with HIV-1 infection with highly active antiretroviral therapy (HAART). Although maternal HAART is clearly warranted in women who require therapy for their own health, the benefits and safety of HAART used solely for prevention of postnatal transmission in healthy women with HIV infection have not yet been demonstrated in clinical trials, although several observational studies suggest it may be effective.12-14 Data from two observational studies in Tanzania have suggested that infant antiretroviral prophylaxis (the MITRA study14) and maternal HAART prophylaxis (the MITRA-Plus study15) may result in similar postnatal transmission rates. Since HAART that is used solely for prophylaxis is stopped after the infant is weaned, the mother may receive 9 months or more of HAART (if therapy is started before birth), followed by an interruption. The effect of interruption of long-term HAART on maternal health is unknown. Some studies have demonstrated an increased risk of disease progression and death among HIV-1–infected adults with high CD4 counts who interrupted treatment, as compared with that associated with continuous therapy.16-18 Antiretroviral treatment of the mother may also expose infants to potential toxic effects or drug resistance if the infant becomes infected because of a potential elevation in the plasma concentration of these drugs in the infant.19-22 Thus, further evaluation of maternal HAART that is used solely for prophylaxis is needed to determine efficacy and long-term safety for both mothers and infants.
On the basis of data from our trial, the 14-week extended nevirapine regimen appears to be safe, with the rate of adverse events similar to that in the control group. This infant-only antiretroviral prophylaxis is practical and effective in reducing HIV-1 transmission and in improving HIV-1–free survival in settings in which breast-feeding is common. The question of whether infants who are born to HIV-1–infected mothers should receive antiretroviral prophylaxis for the entire duration of breast-feeding needs to be assessed, including analysis of safety, added efficacy, and cost-effectiveness.
Supported by a cooperative agreement (5-U50-PS022061-05; award U50-CC0222061) from the Centers for Disease Control and Prevention and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.
The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the National Institutes of Health.
No potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMoa0801941) was published at www.nejm.org on June 4, 2008.
We thank the mothers and children who participated in this study, the nursing and technical staff in Malawi, and several scientists in both the United States and Malawi for their excellent collaboration and help throughout this study, including members of the data and safety monitoring board: K. McIntosh (chair), E. Daar, S. Johnson, N.M.P. King, S. Lagakos, J.Y. Lee, R.J. Levine, M.A. Monteil, K.J. Sikkema, B.S.M. Mwale, S.I. Bangdiwala, R. DiClemente, K. Edwards, L. Walters, and D.O. Dixon.
Source Information
From the Bloomberg School of Public Health (N.I.K., Q.L., T.M., T.E.T.) and School of Medicine (M.G.F.), Johns Hopkins University, Baltimore; Rutgers University, Piscataway, NJ (D.R.H.); Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD (L.M.M.); Centers for Disease Control and Prevention, Atlanta (M.C.T., M.B.); and the University of Malawi College of Medicine (G.K.) and Johns Hopkins University–College of Medicine Research Project (L.M., K.N.), Blantyre, Malawi.
Address reprint requests to Dr. Taha at Rm. E7138, Department of Epidemiology, Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, or at ttaha@jhsph.edu.
- References
References
1
Wilfert CM ,Fowler MG . Balancing maternal and infant benefits and the consequences of breast-feeding in the developing world during the era of HIV infection. J Infect Dis 2007;195:165-167
CrossRef | Web of Science | Medline2
Volmink J ,Siegfried NL ,van der Merwe L ,Brocklehurst P . Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database Syst Rev 2007;1:CD003510-CD003510
Medline3
Petra Study Team
CrossRef | Web of Science | Medline4
Leroy V ,Karon JM ,Alioum A , et al. Twenty-four month efficacy of a maternal short-course zidovudine regimen to prevent mother to child transmission of HIV-1 in West Africa. AIDS 2002;16:631-641
CrossRef | Web of Science | Medline5
John-Stewart G ,Mbori-Ngacha D ,Ekpini R , et al. Breast-feeding and transmission of HIV-1. J Acquir Immune Defic Syndr 2004;35:196-202[Erratum, J Acquir Immune Defic Syndr 2004;35:539.]
CrossRef | Web of Science | Medline6
Taha TE ,Kumwenda NI ,Hoover DR , et al. Nevirapine and zidovudine at birth to reduce perinatal transmission of HIV in an African setting: a randomized controlled trial. JAMA 2004;292:202-209
CrossRef | Web of Science | Medline7
Taha TE ,Kumwenda NI ,Gibbons A , et al. Short postexposure prophylaxis in newborn babies to reduce mother-to-child transmission of HIV-1: NVAZ randomised clinical trial. Lancet 2003;362:1171-1177
CrossRef | Web of Science | Medline8
Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: towards universal access: recommendations for a public health approach. Geneva: World Health Organization, 2006. (Accessed May 27, 2008, at http://www.who.int/hiv/pub/guidelines/pmtctguidelines3.pdf.)
9
Gray GE ,Urban M ,Chersich MF , et al. A randomized trial of two postexposure prophylaxis regimens to reduce mother-to-child HIV-1 transmission in infants of untreated mothers. AIDS 2005;19:1289-1297
CrossRef | Web of Science | Medline10
Wiktor SZ ,Ekpini E ,Karon JM , et al. Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Côte d'Ivoire: a randomised trial. Lancet 1999;353:781-785
CrossRef | Web of Science | Medline11
Hollander M, Wolfe DA. Nonparametric statistical methods. New York: Wiley, 1973:120-3.
12
Arendt V, Ndimubanzi P, Vyankandondera J, et al. AMATA study: effectiveness of antiretroviral therapy in breastfeeding mothers to prevent post-natal vertical transmission in Rwanda. In: Proceedings of the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, July 20–25, 2007:96.
13
Thomas T, Masaba R, Ndivo R, et al. PMTCT of HIV-1 among breastfeeding women using HAART: the Kisumu Breastfeeding Study, Kisumu, Kenya, 2003-2007. In: Program and abstracts of the 15th Conference on Retroviruses and Opportunistic Infections, Boston, February 3–6, 2008:87.
14
Kilewo C, Karlsson K, Ngarina M, et al. Prevention of mother to child transmission through breastfeeding by treating infants or mothers prophylactically with antiretrovirals in Dar es Salaam, Tanzania — the MITRA and MITRA PLUS studies. In: Proceedings of the 4th Dominique Dormont International Conference: Host-Pathogen Interactions in Chronic Infections, Paris, December 13–15, 2007:56.
15
Kilewo C, Karlsson K, Ngarina M, et al. Prevention of mother to child transmission of HIV-1 through breastfeeding by treating mothers prophylactically with triple antiretroviral therapy in Dar es Salaam, Tanzania — the MITRA PLUS study. In: Proceedings of the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention, Sydney, July 20–25, 2007:96.
16
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group
Full Text | Web of Science | Medline17
Danel C ,Moh R ,Minga A , et al. CD4-guided structured antiretroviral treatment interruption strategy in HIV-infected adults in West Africa (Trivacan ANRS 1269 trial): a randomised trial. Lancet 2006;367:1981-1989
CrossRef | Web of Science | Medline18
The Strategies for Management of Antiretroviral Therapy (SMART) Study Group
CrossRef | Web of Science | Medline19
Shapiro RL ,Holland DT ,Capparelli E , et al. Antiretroviral concentrations in breast-feeding infants of women in Botswana receiving antiretroviral treatment. J Infect Dis 2005;192:720-727
CrossRef | Web of Science | Medline20
Mirochnick M, Thomas T, Capparelli E, et al. Plasma antiretroviral concentrations in breast-feeding infants whose mothers are receiving HAART. In: Program and abstracts of the 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, February 25–28, 2007:91.
21
Bulterys M ,Weidle PJ ,Abrams EJ ,Fowler MG . Combination antiretroviral therapy in African nursing mothers and drug exposure in their infants: new pharmacokinetic and virologic findings. J Infect Dis 2005;192:709-712
CrossRef | Web of Science | Medline22
Zeh C, Weidle P, Nafisa L, et al. Emergence of HIV-1 drug resistance among breastfeeding infants born to HIV-infected mothers taking antiretrovirals for prevention of mother to child transmission of HIV: the Kisumu Breastfeeding Study, Kenya. In: Program and abstracts of the 15th Conference on Retroviruses and Opportunistic Infections, Boston, February 3–6, 2008:102.
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Jim Aizire, Mary Glenn Fowler, Jing Wang, Avinash K. Shetty, Lynda Stranix-Chibanda, Moreen Kamateeka, Elizabeth R. Brown, Steve G. Bolton, Philippa M. Musoke, Hoosen Coovadia. (2012) Extended prophylaxis with nevirapine and cotrimoxazole among HIV-exposed uninfected infants is well tolerated. AIDS 26:3, 325-333
CrossRef5
J. M. Marrazzo, W. Cates. (2011) Interventions to Prevent Sexually Transmitted Infections, Including HIV Infection. Clinical Infectious Diseases 53:suppl 3, S64-S78
CrossRef6
Lynne M. Mofenson. (2011) Prevention of Mother-to-Child HIV-1 Transmission—Why We Still Need a Preventive HIV Immunization Strategy. JAIDS Journal of Acquired Immune Deficiency Syndromes 58:4, 359-362
CrossRef7
Carolyne Onyango-Makumbi, Saad B. Omer, Michael Mubiru, Lawrence H. Moulton, Clemensia Nakabiito, Philippa Musoke, Francis Mmiro, Sheryl Zwerski, Hans Wigzell, Lars Falksveden, Britta Wahren, Gretchen Antelman, Mary Glenn Fowler, Laura Guay, J. Brooks Jackson. (2011) Safety and Efficacy of HIV Hyperimmune Globulin for Prevention of Mother-to-Child HIV Transmission in HIV-1–Infected Pregnant Women and Their Infants in Kampala, Uganda (HIVIGLOB/NVP STUDY). JAIDS Journal of Acquired Immune Deficiency Syndromes 58:4, 399-407
CrossRef8
LeeAnne M. Luft, M. John Gill, Deirdre L. Church. (2011) HIV-1 viral diversity and its implications for viral load testing: review of current platforms. International Journal of Infectious Diseases 15:10, e661-e670
CrossRef9
T. E. Taha, D. R. Hoover, S. Chen, N. I. Kumwenda, L. Mipando, K. Nkanaunena, M. C. Thigpen, A. Taylor, M. G. Fowler, L. M. Mofenson. (2011) Effects of Cessation of Breastfeeding in HIV-1-Exposed, Uninfected Children in Malawi. Clinical Infectious Diseases 53:4, 388-395
CrossRef10
Deborah Persaud, Abubaker Bedri, Carrie Ziemniak, Anitha Moorthy, Berhanu Gudetta, Aida Abashawl, Yohannes Mengistu, Saad B. Omer, Abdulhamid Isehak, Solomon Kumbi, Rahel Adamu, Sileshi Lulseged, Roxann Ashworth, Elham Hassen, Andrea Ruff, and the Ethiopian SWEN Study. (2011) Slower Clearance of Nevirapine Resistant Virus in Infants Failing Extended Nevirapine Prophylaxis for Prevention of Mother-to-Child HIV Transmission. AIDS Research and Human Retroviruses 27:8, 823-829
CrossRef11
Laura Guay. (2011) Decreasing HIV Transmission Through Breastfeeding: Moving From Evidence to Practice. JAIDS Journal of Acquired Immune Deficiency Syndromes 57:4, 258-260
CrossRef12
Taha E Taha, Qing Li, Donald R Hoover, Linda Mipando, Kondwani Nkanaunena, Michael C Thigpen, Allan Taylor, Johnstone Kumwenda, Mary Glenn Fowler, Lynne M Mofenson, Newton I Kumwenda. (2011) Postexposure Prophylaxis of Breastfeeding HIV-Exposed Infants With Antiretroviral Drugs to Age 14 Weeks: Updated Efficacy Results of the PEPI-Malawi Trial. JAIDS Journal of Acquired Immune Deficiency Syndromes 57:4, 319-325
CrossRef13
Kirsten Salado-Rasmussen, Zahra Persson Theilgaard, Mercy Chiduo, Court Pedersen, Jan Gerstoft, Terese Lea Katzenstein. (2011) Good performance of an immunoassay based method for nevirapine measurements in human breast milk. Clinical Chemistry and Laboratory Medicine 49:7, 1171-1175
CrossRef14
Taha E. Taha, Maria M. James, Donald R. Hoover, Jin Sun, Oliver Laeyendecker, Caroline E. Mullis, Johnstone J. Kumwenda, Jairam R. Lingappa, Bertran Auvert, Charles S. Morrison, Lynne M. Mofensen, Allan Taylor, Mary G. Fowler, Newton I. Kumenda, Susan H. Eshleman. (2011) Association of recent HIV infection and in-utero HIV-1 transmission. AIDS 25:11, 1357-1364
CrossRef15
Mary A. Vogler, Harjot Singh, Rodney Wright. (2011) Complex Decisions in Managing HIV Infection During Pregnancy. Current HIV/AIDS Reports 8:2, 122-131
CrossRef16
Wendy Ferguson, Michele Goode, Amanda Walsh, Patrick Gavin, Karina Butler. (2011) Evaluation of 4 Weeksʼ Neonatal Antiretroviral Prophylaxis as a Component of a Prevention of Mother-to-child Transmission Program in a Resource-rich Setting. The Pediatric Infectious Disease Journal 30:5, 408-412
CrossRef17
Taha E. Taha. (2011) Mother-to-child transmission of HIV-1 in sub-Saharan Africa: Past, present and future challenges. Life Sciences 88:21-22, 917-921
CrossRef18
Daniel W. Sellen, Craig Hadley. (2011) FOOD INSECURITY AND MATERNAL-TO-CHILD TRANSMISSION OF HIV AND AIDS IN SUB-SAHARAN AFRICA. Annals of Anthropological Practice 35:1, 28-49
CrossRef19
Eric D. McCollum, Geoffrey A. Preidis, Carrie L. Golitko, Linias D. Siwande, Charles Mwansambo, Peter N. Kazembe, Irving Hoffman, Mina C. Hosseinipour, Gordon E. Schutze, Mark W. Kline. (2011) Routine Inpatient Human Immunodeficiency Virus Testing System Increases Access to Pediatric Human Immunodeficiency Virus Care in Sub-Saharan Africa. The Pediatric Infectious Disease Journal 30:5, e75-e81
CrossRef20
J. Fogel, Q. Li, T. E. Taha, D. R. Hoover, N. I. Kumwenda, L. M. Mofenson, J. J. Kumwenda, M. G. Fowler, M. C. Thigpen, S. H. Eshleman. (2011) Initiation of Antiretroviral Treatment in Women After Delivery Can Induce Multiclass Drug Resistance in Breastfeeding HIV-Infected Infants. Clinical Infectious Diseases 52:8, 1069-1076
CrossRef21
Jessica Fogel, Donald R Hoover, Jin Sun, Lynne M Mofenson, Mary G Fowler, Allan W Taylor, Newton Kumwenda, Taha E Taha, Susan H Eshleman. (2011) Analysis of nevirapine resistance in HIV-infected infants who received extended nevirapine or nevirapine/zidovudine prophylaxis. AIDS 25:7, 911-917
CrossRef22
Elijah Paintsil. (2011) Resistance, resistance, go away: persistence of nevirapine-resistant HIV mutations in HIV-infected infants. AIDS 25:7, 997-999
CrossRef23
K. K. Venkatesh, G. de Bruyn, E. Marinda, K. Otwombe, R. van Niekerk, M. Urban, E. W. Triche, S. T. McGarvey, M. N. Lurie, G. E. Gray. (2011) Morbidity and Mortality among Infants Born to HIV-Infected Women in South Africa: Implications for Child Health in Resource-Limited Settings. Journal of Tropical Pediatrics 57:2, 109-119
CrossRef24
Saad B Omer. (2011) Twelve-month follow-up of Six Week Extended Dose Nevirapine randomized controlled trials: differential impact of extended-dose nevirapine on mother-to-child transmission and infant death by maternal CD4 cell count. AIDS 25:6, 767-776
CrossRef25
(2011) Triple antiretroviral compared with zidovudine and single-dose nevirapine prophylaxis during pregnancy and breastfeeding for prevention of mother-to-child transmission of HIV-1 (Kesho Bora study): a randomised controlled trial. The Lancet Infectious Diseases 11:3, 171-180
CrossRef26
A. Moorthy, L. Kuhn, A. Coovadia, T. Meyers, R. Strehlau, G. Sherman, W.-Y. Tsai, Y. H. Chen, E. J. Abrams, D. Persaud. (2011) Induction Therapy with Protease-Inhibitors Modifies the Effect of Nevirapine Resistance on Virologic Response to Nevirapine-based HAART in Children. Clinical Infectious Diseases 52:4, 514-521
CrossRef27
Chokechai Rongkavilit, Basim I. Asmar. (2011) Advances in Prevention of Mother-to-Child HIV Transmission: The International Perspectives. The Indian Journal of Pediatrics 78:2, 192-204
CrossRef28
2011. Part Introduction. , 33-280.
CrossRef29
Diane Valea, Edouard Tuaillon, Yassine Al Tabaa, François Rouet, Pierre-Alain Rubbo, Nicolas Meda, Vincent Foulongne, Karine Bollore, Nicolas Nagot, Philippe Van de Perre, Jean-Pierre Vendrell. (2011) CD4+ T cells spontaneously producing human immunodeficiency virus type I in breast milk from women with or without antiretroviral drugs. Retrovirology 8:1, 34
CrossRef30
SO Mepham, RM Bland, M-L Newell. (2011) Prevention of mother-to-child transmission of HIV in resource-rich and -poor settings. BJOG: An International Journal of Obstetrics & Gynaecology 118:2, 202-218
CrossRef31
The Kesho Bora Study Group. (2011) Safety and effectiveness of antiretroviral drugs during pregnancy, delivery and breastfeeding for prevention of mother-to-child transmission of HIV-1: The Kesho Bora Multicentre Collaborative Study rationale, design, and implementation challenges. Contemporary Clinical Trials 32:1, 74-85
CrossRef32
M. Adhikari, P. Jeena, R. Bobat, M. Archary, K. Naidoo, A. Coutsoudis, R. Singh, N. Nair. (2011) HIV-Associated Tuberculosis in the Newborn and Young Infant. International Journal of Pediatrics 2011, 1-10
CrossRef33
Tanya Doherty, David Sanders, Ameena Goga, Debra Jackson. (2011) Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa. Bulletin of the World Health Organization 89:1, 62-67
CrossRef34
Gwenn E. McLaughlin, Andrew C. Argent. 2011. Acquired Immune Dysfunction. , 1302-1314.
CrossRef35
Marc Bulterys, Sascha Ellington, Athena P. Kourtis. (2010) HIV-1 and Breastfeeding: Biology of Transmission and Advances in Prevention. Clinics in Perinatology 37:4, 807-824
CrossRef36
Mark Mirochnick, Brookie M. Best, Diana F. Clarke. (2010) Antiretroviral Pharmacology: Special Issues Regarding Pregnant Women and Neonates. Clinics in Perinatology 37:4, 907-927
CrossRef37
Louise Kuhn, Grace Aldrovandi. (2010) Survival and Health Benefits of Breastfeeding Versus Artificial Feeding in Infants of HIV-Infected Women: Developing Versus Developed World. Clinics in Perinatology 37:4, 843-862
CrossRef38
Paul J. Weidle, Steven Nesheim. (2010) HIV Drug Resistance and Mother-to-Child Transmission of HIV. Clinics in Perinatology 37:4, 825-842
CrossRef39
Mary Glenn Fowler, Alicia R. Gable, Margaret A. Lampe, Monica Etima, Maxensia Owor. (2010) Perinatal HIV and Its Prevention: Progress Toward an HIV-free Generation. Clinics in Perinatology 37:4, 699-719
CrossRef40
A. E. N. Nlend, B. B. Ekani. (2010) Preliminary assessment of breastfeeding practices in HIV 1-infected mothers (prior to weaning) under the Djoungolo programme on the prevention of mother-to-child transmission of HIV. Journal of Tropical Pediatrics 56:6, 436-439
CrossRef41
Kartik K. Venkatesh, Mark N. Lurie, Elizabeth W. Triche, Guy De Bruyn, Joseph I. Harwell, Stephen T. McGarvey, Glenda E. Gray. (2010) Growth of infants born to HIV-infected women in South Africa according to maternal and infant characteristics. Tropical Medicine & International Health 15:11, 1364-1374
CrossRef42
Maria C Marazzi, Giuseppe Liotta, Karin Nielsen-Saines, Jere Haswell, Nurja A Magid, Ersilia Buonomo, Paola Scarcella, Anna M Doro Altan, Sandro Mancinelli, Leonardo Palombi. (2010) Extended antenatal antiretroviral use correlates with improved infant outcomes throughout the first year of life. AIDS 24:18, 2819-2826
CrossRef43
Anna Coutsoudis, Leith Kwaan, Mairi Thomson. (2010) Prevention of vertical transmission of HIV-1 in resource-limited settings. Expert Review of Anti-infective Therapy 8:10, 1163-1175
CrossRef44
S. Loubiere, J.-P. Moatti. (2010) Economic evaluation of point-of-care diagnostic technologies for infectious diseases. Clinical Microbiology and Infection 16:8, 1070-1076
CrossRef45
Cade Fields-Gardner. (2010) Position of the American Dietetic Association: Nutrition Intervention and Human Immunodeficiency Virus Infection. Journal of the American Dietetic Association 110:7, 1105-1119
CrossRef46
Chasela, Charles S., Hudgens, Michael G., Jamieson, Denise J., Kayira, Dumbani, Hosseinipour, Mina C., Kourtis, Athena P., Martinson, Francis, Tegha, Gerald, Knight, Rodney J., Ahmed, Yusuf I., Kamwendo, Deborah D., Hoffman, Irving F., Ellington, Sascha R., Kacheche, Zebrone, Soko, Alice, Wiener, Jeffrey B., Fiscus, Susan A., Kazembe, Peter, Mofolo, Innocent A., Chigwenembe, Maggie, Sichali, Dorothy S., van der Horst, Charles M., . (2010) Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission. New England Journal of Medicine 362:24, 2271-2281
Full Text47
Mofenson, Lynne M., . (2010) Protecting the Next Generation — Eliminating Perinatal HIV-1 Infection. New England Journal of Medicine 362:24, 2316-2318
Full Text48
Tony Walls, Pamela Palasanthiran, Jennie Studdert, Kieran Moran, John B Ziegler. (2010) Breastfeeding in mothers with HIV. Journal of Paediatrics and Child Health 46:6, 349-352
CrossRef49
Haroon Saloojee, Peter A Cooper. (2010) Feeding of infants of HIV-positive mothers. Current Opinion in Clinical Nutrition and Metabolic Care 13:3, 336-343
CrossRef50
Kwasi Torpey, Prisca Kasonde, Mushota Kabaso, Mark A Weaver, Gail Bryan, Victor Mukonka, Maximillian Bweupe, Chilunje Zimba, Felicitas Mwale, Robert Colebunders. (2010) Reducing Pediatric HIV Infection: Estimating Mother to Child Transmission Rates in a Program Setting in Zambia. JAIDS Journal of Acquired Immune Deficiency Syndromes1
CrossRef51
Mackenzie Slater, Elizabeth M. Stringer, Jeffrey S.A. Stringer. (2010) Breastfeeding in HIV-Positive Women. Pediatric Drugs 12:1, 1-9
CrossRef52
Sarah E Hudelson, Michelle S McConnell, Danstan Bagenda, Estelle Piwowar-Manning, Teresa L Parsons, Monica L Nolan, Paul M Bakaki, Michael C Thigpen, Michael Mubiru, Mary Glenn Fowler, Susan H Eshleman. (2010) Emergence and persistence of nevirapine resistance in breast milk after single-dose nevirapine administration. AIDS 24:4, 557-561
CrossRef53
J. G. Garcia-Lerma, M.-e. Cong, J. Mitchell, A. S. Youngpairoj, Q. Zheng, S. Masciotra, A. Martin, Z. Kuklenyik, A. Holder, J. Lipscomb, C.-P. Pau, J. R. Barr, D. L. Hanson, R. Otten, L. Paxton, T. M. Folks, W. Heneine. (2010) Intermittent Prophylaxis with Oral Truvada Protects Macaques from Rectal SHIV Infection. Science Translational Medicine 2:14, 14ra4-14ra4
CrossRef54
James McIntyre. (2010) Use of antiretrovirals during pregnancy and breastfeeding in low-income and middle-income countries. Current Opinion in HIV and AIDS 5:1, 48-53
CrossRef55
Bonus Makanani, Johnstone Kumwenda, Newton Kumwenda, Shu Chen, Amy Tsui, Taha E. Taha. (2010) Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi. International Journal of Gynecology & Obstetrics 108:1, 26-30
CrossRef56
Carey Farquhar, Dorothy Mbori-Ngacha, Julie Overbaugh, Dalton Wamalwa, Jennifer Harris, Rose Bosire, Grace John-Stewart. (2010) Illness during pregnancy and bacterial vaginosis are associated with in-utero HIV-1 transmission. AIDS 24:1, 153-155
CrossRef57
Carolyne Onyango-Makumbi, Danstan Bagenda, Antony Mwatha, Saad B Omer, Philippa Musoke, Francis Mmiro, Sheryl L Zwerski, Brenda Asiimwe Kateera, Maria Musisi, Mary Glenn Fowler, J Brooks Jackson, Laura A Guay. (2010) Early Weaning of HIV-Exposed Uninfected Infants and Risk of Serious Gastroenteritis: Findings from Two Perinatal HIV Prevention Trials in Kampala, Uganda. JAIDS Journal of Acquired Immune Deficiency Syndromes 53:1, 20-27
CrossRef58
Jaco Homsy, David Moore, Alex Barasa, Willi Were, Celina Likicho, Bernard Waiswa, Robert Downing, Samuel Malamba, Jordan Tappero, Jonathan Mermin. (2010) Breastfeeding, Mother-to-Child HIV Transmission, and Mortality Among Infants Born to HIV-Infected Women on Highly Active Antiretroviral Therapy in Rural Uganda. JAIDS Journal of Acquired Immune Deficiency Syndromes 53:1, 28-35
CrossRef59
Jean H Humphrey. (2010) The Risks of Not Breastfeeding. JAIDS Journal of Acquired Immune Deficiency Syndromes 53:1, 1-4
CrossRef60
Samuel Broder. (2010) The development of antiretroviral therapy and its impact on the HIV-1/AIDS pandemic. Antiviral Research 85:1, 1-18
CrossRef61
Jessica Lidström, Qing Li, Donald R Hoover, George Kafulafula, Lynne M Mofenson, Mary G Fowler, Michael C Thigpen, Newton Kumwenda, Taha E Taha, Susan H Eshleman. (2010) Addition of extended zidovudine to extended nevirapine prophylaxis reduces nevirapine resistance in infants who were HIV-infected in utero. AIDS 24:3, 381-386
CrossRef62
Jennifer S. Read, N M. Samuel, Parameshwari Srijayanth, Shoba Dharmarajan, Hannah M. Van Hook, Mini Jacob, Viju Junankar, James Bethel, Eunice Yu, Sonia K. Stoszek. (2010) Infants of Human Immunodeficiency Virus Type 1-Infected Women in Rural South India. The Pediatric Infectious Disease Journal 29:1, 14-17
CrossRef63
George Kafulafula, Donald R Hoover, Taha E Taha, Michael Thigpen, Qing Li, Mary Glenn Fowler, Newton I Kumwenda, Kondwani Nkanaunena, Linda Mipando, Lynne M Mofenson. (2010) Frequency of Gastroenteritis and Gastroenteritis-Associated Mortality With Early Weaning in HIV-1-Uninfected Children Born to HIV-Infected Women in Malawi. JAIDS Journal of Acquired Immune Deficiency Syndromes 53:1, 6-13
CrossRef64
Marc Bulterys, Catherine M Wilfert. (2009) HAART during pregnancy and during breastfeeding among HIV-infected women in the developing world: has the time come?. AIDS 23:18, 2473-2477
CrossRef65
Charles Kilewo, Katarina Karlsson, Matilda Ngarina, Augustine Massawe, Eligius Lyamuya, Andrew Swai, Rosina Lipyoga, Fred Mhalu, Gunnel Biberfeld. (2009) Prevention of Mother-to-Child Transmission of HIV-1 Through Breastfeeding by Treating Mothers With Triple Antiretroviral Therapy in Dar es Salaam, Tanzania: The Mitra Plus Study. JAIDS Journal of Acquired Immune Deficiency Syndromes 52:3, 406-416
CrossRef66
Myung Shin K. Sim, William G. Cumberland, Naihua Duan, Yvonne J. Bryson. (2009) Modeling vertical transmission of HIV: Imperfect vaccines can be of benefit. Vaccine 27:50, 7003-7010
CrossRef67
Cécile Alexandra Peltier, Gilles François Ndayisaba, Philippe Lepage, Johan van Griensven, Valériane Leroy, Christine Omes Pharm, Patrick Cyaga Ndimubanzi, Olivier Courteille, Vic Arendt. (2009) Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS 23:18, 2415-2423
CrossRef68
Lynne M Mofenson. (2009) Prevention of Breast Milk Transmission of HIV: The Time Is Now. JAIDS Journal of Acquired Immune Deficiency Syndromes 52:3, 305-308
CrossRef69
CN Mnyani, JA McIntyre. (2009) Preventing mother-to-child transmission of HIV. BJOG: An International Journal of Obstetrics & Gynaecology 116, 71-76
CrossRef70
Nicolas A. Menzies, Jaco Homsy, Jeannie Y. Chang Pitter, Christian Pitter, Jonathan Mermin, Robert Downing, Thomas Finkbeiner, John Obonyo, Adeodata Kekitiinwa, Jordan Tappero, John M. Blandford. (2009) Cost-Effectiveness of Routine Rapid Human Immunodeficiency Virus Antibody Testing Before DNA-PCR Testing for Early Diagnosis of Infants in Resource-Limited Settings. The Pediatric Infectious Disease Journal 28:9, 819-825
CrossRef71
Philippe Msellati. (2009) Improving mothers' access to PMTCT programs in West Africa: A public health perspective. Social Science & Medicine 69:6, 807-812
CrossRef72
Arthur J Ammann. (2009) Optimal Versus Suboptimal Treatment for HIV-Infected Pregnant Women and HIV-Exposed Infants in Clinical Research Studies. JAIDS Journal of Acquired Immune Deficiency Syndromes 51:5, 509-512
CrossRef73
M. Adhikari. (2009) Tuberculosis and tuberculosis/HIV co-infection in pregnancy. Seminars in Fetal and Neonatal Medicine 14:4, 234-240
CrossRef74
Wayne A. Duffus, Ikechukwu U. Ogbuanu. (2009) Prevention counseling for HIV-infected persons: What every clinician needs to know. Current Infectious Disease Reports 11:4, 319-326
CrossRef75
Hoosen Coovadia. (2009) Current issues in prevention of mother-to-child transmission of HIV-1. Current Opinion in HIV and AIDS 4:4, 319-324
CrossRef76
FRANCO GUIDOZZI, VIVIAN BLACK. (2009) The Obstetric Face and Challenge of HIV/AIDS. Clinical Obstetrics and Gynecology 52:2, 270-284
CrossRef77
Ravindra K Gupta, Diana M Gibb, Deenan Pillay. (2009) Management of paediatric HIV-1 resistance. Current Opinion in Infectious Diseases 22:3, 256-263
CrossRef78
Ameena E Goga, Brian Van Wyk, Tanya Doherty, Mark Colvin, Debra J Jackson, Mickey Chopra. (2009) Operational Effectiveness of Guidelines on Complete Breast-Feeding Cessation to Reduce Mother-to-Child Transmission of HIV: Results From a Prospective Observational Cohort Study at Routine Prevention of Mother-to-Child Transmission Sites, South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes 50:5, 521-528
CrossRef79
Michelle Giles. (2009) HIV and pregnancy: screening and management update. Current Opinion in Obstetrics and Gynecology 21:2, 131-135
CrossRef80
Hendramoorthy Maheswaran, Ruth M Bland. (2009) Preventing mother-to-child transmission of HIV in resource-limited settings. Future Virology 4:2, 165-175
CrossRef81
Suzanne Filteau. (2009) The HIV-exposed, uninfected African child. Tropical Medicine & International Health 14:3, 276-287
CrossRef82
Debra J. Jackson, Ameena E. Goga, Tanya Doherty, Mickey Chopra. (2009) An Update on HIV and Infant Feeding Issues in Developed and Developing Countries. Journal of Obstetric, Gynecologic, & Neonatal Nursing 38:2, 219-229
CrossRef83
Louise Kuhn, Cordula Reitz, Elaine J Abrams. (2009) Breastfeeding and AIDS in the developing world. Current Opinion in Pediatrics 21:1, 83-93
CrossRef84
Roger L. Shapiro, Laura Smeaton, Shahin Lockman, Ibou Thior, Raabya Rossenkhan, Carolyn Wester, Lisa Stevens, Claire Moffat, Peter Arimi, Patrick Ndase, Aida Asmelash, Jean Leidner, Vladimir Novitsky, Joseph Makhema, Max Essex. (2009) Risk Factors for Early and Late Transmission of HIV via Breast‐Feeding among Infants Born to HIV‐Infected Women in a Randomized Clinical Trial in Botswana. The Journal of Infectious Diseases 199:3, 414-418
CrossRef85
Tara Horvath, Banyana C Madi, Irene M Iuppa, Gail E Kennedy, George W Rutherford, Jennifer S. Read, Tara Horvath. 2009. Interventions for preventing late postnatal mother-to-child transmission of HIV. .
CrossRef86
Charles van der Horst, Charles Chasela, Yusuf Ahmed, Irving Hoffman, Mina Hosseinipour, Rodney Knight, Susan Fiscus, Michael Hudgens, Peter Kazembe, Margaret Bentley, Linda Adair, Ellen Piwoz, Francis Martinson, Ann Duerr, Athena Kourtis, A. Edde Loeliger, Beth Tohill, Sascha Ellington, Denise Jamieson. (2009) Modifications of a large HIV prevention clinical trial to fit changing realities: A case study of the Breastfeeding, Antiretroviral, and Nutrition (BAN) protocol in Lilongwe, Malawi. Contemporary Clinical Trials 30:1, 24-33
CrossRef87
Glenda E Gray. (2008) Antiretroviral strategies for preventing breast milk transmission of HIV. Pediatric Health 2:6, 697-700
CrossRef88
Andrea L Ciaranello, George R Seage, Kenneth A Freedberg, Milton C Weinstein, Shahin Lockman, Rochelle P Walensky. (2008) Antiretroviral drugs for preventing mother-to-child transmission of HIV in sub-Saharan Africa: balancing efficacy and infant toxicity. AIDS 22:17, 2359-2369
CrossRef89
(2008) Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission. New England Journal of Medicine 359:17, 1845-1848
Full Text90
Jennifer S. Read, Michael J. Cannon, Lawrence R. Stanberry, Susan Schuval. (2008) Prevention of Mother-to-Child Transmission of Viral Infections. Current Problems in Pediatric and Adolescent Health Care 38:9, 274-297
CrossRef91
Faith E. Fletcher, Paul Ndebele, Maureen C. Kelley. (2008) Infant feeding and HIV in Sub-Saharan Africa: what lies beneath the dilemma?. Theoretical Medicine and Bioethics 29:5, 307-330
CrossRef92
Nancy S Padian, Anne Buvé, Jennifer Balkus, David Serwadda, Ward Cates. (2008) Biomedical interventions to prevent HIV infection: evidence, challenges, and way forward. The Lancet 372:9638, 585-599
CrossRef93
Gray, Glenda E., Saloojee, Haroon, . (2008) Breast-Feeding, Antiretroviral Prophylaxis, and HIV. New England Journal of Medicine 359:2, 189-191
Full Text94
Jeffrey SA Stringer, Benjamin H Chi. (2008) Extended nevirapine prophylaxis to prevent HIV transmission. The Lancet 372:9635, 267-269
CrossRef95
HM Coovadia, Jane G Schaller. (2008) HIV/AIDS in children: a disaster in the making. The Lancet 372:9635, 271-273
CrossRef
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