Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission

Nicole L. Davis, William C. Miller, Michael G. Hudgens, Charles S. Chasela, Dorothy Sichali, Dumbani Kayira, Julie A E Nelson, Jeffrey S A Stringer, Sascha R. Ellington, Athena P. Kourtis, Denise J. Jamieson, Charles Van Der Horst, Linda Adair, Yusuf Ahmed, Mounir Ait-Khaled, Sandra Albrecht, Shrikant Bangdiwala, Ronald Bayer, Margaret Bentley, Brian BramsonEmily Bobrow, Nicola Boyle, Sal Butera, Charity Chavula, Joseph Chimerang'ambe, Maggie Chigwenembe, Maria Chikasema, Norah Chikhungu, David Chilongozi, Grace Chiudzu, Lenesi Chome, Anne Cole, Amanda Corbett, Amy Corneli, Anna Dow, Ann Duerr, Henry Eliya, Joseph Eron, Sherry Farr, Yvonne Owens Ferguson, Susan Fiscus, Valerie Flax, Ali Fokar, Shannon Galvin, Laura Guay, Chad Heilig, Irving Hoffman, Elizabeth Hooten, Mina Hosseinipour, Stacy Hurst, Lisa Hyde, George Joaki, David Jones, Elizabeth Jordan-Bell, Zebrone Kacheche, Esmie Kamanga, Gift Kamanga, Coxcilly Kampani, Portia Kamthunzi, Deborah Kamwendo, Cecilia Kanyama, Angela Kashuba, Damson Kathyola, Peter Kazembe, Caroline C. King, Rodney Knight, Robert Krysiak, Jacob Kumwenda, Hana Lee, Edde Loeliger, Dustin Long, Misheck Luhanga, Victor Madhlopa, Maganizo Majawa, Alice Maida, Cheryl Marcus, Francis Martinson, Navdeep Thoofer, Chrissie Matiki, Douglas Mayers, Isabel Mayuni, Marita McDonough, Joyce Meme, Ceppie Merry, Khama Mita, Chimwemwe Mkomawanthu, Gertrude Mndala, Ibrahim Mndala, Agnes Moses, Albans Msika, Wezi Msungama, Beatrice Mtimuni, Jane Muita, Noel Mumba, Bonface Musis, Charles Mwansambo, Gerald Mwapasa, Jacqueline Nkhoma, Megan Parker, Richard Pendame, Ellen Piwoz, Byron Raines, Zane Ramdas, John Rublein, Mairin Ryan, Ian Sanne, Christopher Sellers, Diane Shugars, Wendy Snowden, Alice Soko, Allison Spensley, Jean Marc Steens, Gerald Tegha, Martin Tembo, Roshan Thomas, Hsiao Chuan Tien, Beth Tohill, Esther Waalberg, Elizabeth Widen, Jeffrey Wiener, Cathy Wilfert, Patricia Wiyo, Innocent Zgambo, Chifundo Zimba

Research output: Contribution to journalArticle

Abstract

Objective: Estimate association between postpartum antiretroviral adherence and breast milk HIV-1 transmission. Design: Prospective cohort study. Methods: Mother-infant pairs were randomized after delivery to immediately begin receiving 28 weeks of either triple maternal antiretrovirals (zidovudine, lamivudine, and either nevirapine, nelfinavir, or lopinavir-ritonavir) or daily infant nevirapine as part of the Breastfeeding, Antiretrovirals, and Nutrition (BAN) study. Associations between postpartum antiretroviral adherence and rate of breast milk HIV-1 transmission were estimated using Coxmodels.Wemeasured adherence over four postpartumtimeintervals using pill count, suspension bottle weight, and maternal self-report. Adherence was categorized and lagged by one interval. Missing adherence measures were multiply imputed. Infant HIV-1 infection was determined by DNA PCR every 2-6 weeks. The primary endpoint was infant HIV-1 infection by 38 weeks of age among infants alive and uninfected at 5 weeks. Results: Analyses included 1479 mother-infant pairs and 45 transmission events. Using pill count and bottle weight information, 22-40% of mother-infant pairs at any given interval were less than 90% adherent. Having at least 90% adherence was associated with a 52% [95% confidence interval (CI) 3-76] relative reduction in the rate of breast milk HIV-1 transmission, compared with having less than 90% adherence when controlling for study arm, breastfeeding status, and maternal characteristics. Complete case analysis rendered similar results (n=501; relative reduction 59%, 95% CI 6-82). Conclusion: Nonadherence to extended postpartum antiretroviral regimens in 'real world' settings is likely to be higher than that seen in BAN. Identifying mothers with difficulty adhering to antiretrovirals, and developing effective adherence interventions, will help maximize benefits of antiretroviral provision throughout breastfeeding.

Original languageEnglish (US)
Pages (from-to)2739-2749
Number of pages11
JournalAIDS
Volume28
Issue number18
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Adherence
  • Antiretroviral
  • Breastfeeding
  • HIV transmission
  • Prevention of mother-to-child HIV transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Davis, N. L., Miller, W. C., Hudgens, M. G., Chasela, C. S., Sichali, D., Kayira, D., Nelson, J. A. E., Stringer, J. S. A., Ellington, S. R., Kourtis, A. P., Jamieson, D. J., Van Der Horst, C., Adair, L., Ahmed, Y., Ait-Khaled, M., Albrecht, S., Bangdiwala, S., Bayer, R., Bentley, M., ... Zimba, C. (2014). Adherence to extended postpartum antiretrovirals is associated with decreased breast milk HIV-1 transmission. AIDS, 28(18), 2739-2749. https://doi.org/10.1097/QAD.0000000000000492