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Extended Nevirapine Course Found to Reduce HIV Transmission and Death in Breastfed Infants of HIV-infected Mothers

Three international research teams supported by NIAID and NICHD have shown that giving an extended daily regimen of the antiretroviral drug nevirapine (NVP) to breastfeeding babies of HIV-infected mothers reduces the risk of acquiring HIV and death compared to those who received a single dose of NVP at birth, which is the current standard of care.

African health center in Xai-Xai City, Mozambique
African health centers, like this one Xai-Xai City, Mozambique, provide prevention of mother-to-child transmission services, as well as a support group for women living with HIV. © UNICEF Mozambique/2008/Machiana
Worldwide, approximately 150,000 infants annually acquire HIV through breastfeeding, and the risk of HIV transmission is generally believed to be greatest during the earliest months of life. Yet, the WHO and UNICEF recommend that infants born to HIV-infected mothers who lack access to safe, affordable, and sustainable replacement feeding be breastfed for at least six months. The rationale for this recommendation is that breastfeeding may protect infants from other illnesses that pose a greater risk of death than HIV infection.

The three NIAID-supported trials, which were combined and called the Six-Week Extended Nevirapine (SWEN) studies, took place in Ethiopia, India, and Uganda between 2001 and 2007. Approximately 2,000 mother-infant pairs participated.

The investigators found that NVP given once daily to breastfeeding infants from days 8 to 42 of life cut the rate of HIV transmission by almost half at six weeks when compared with a single dose of NVP given to infants at birth. Moreover, the risk of postnatal HIV infection or death for babies at six months of age who received extended NVP was nearly one-third less than the risk for infants given only a single dose at birth.

These findings demonstrate that an extended course of NVP has the potential to greatly reduce HIV transmission and death in babies born to HIV-infected mothers who breastfeed when it is the only practical option. The results of the SWEN studies and related clinical trials could lead to a change in the global standard of care in resource-limited settings for preventing HIV transmission through breastfeeding.

The SWEN studies were led by scientists from the Johns Hopkins University in collaboration with co-investigators at Addis Ababa University Faculty of Medicine in Addis Ababa, Ethiopia; at BJ Medical College and National AIDS Research Institute in Pune, India; and at the Makerere University/Johns Hopkins University Research Collaboration and the Ugandan Ministry of Health in Kampala, Uganda.

Learn more about the SWEN studies.

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Last Updated April 14, 2008