Combination Antiretroviral Therapy in African Nursing Mothers and Drug Exposure in Their Infants: New Pharmacokinetic and Virologic Findings

Abstract

Africa’s HIV/AIDS epidemic has reached crisis proportions and calls for a rapid expansion of both prevention and treatment services particularly among young women and children. Mother-to-child transmission (MTCT) is the most important source of HIV-1 infection in children and prolonged breast-feeding is associated with a near doubling of the risk of MTCT. In resource-limited settings the majority of HIV-1–infected mothers choose to breast-feed because of cultural norms the high cost of formula the lack of a safe water supply and the stigma associated with not breast-feeding. Reducing HIV-1 transmission during lactation remains a pressing global health dilemma confronting HIV-1–infected women health-care providers and policy makers. Clinical trials are currently under way to assess whether the use of highly active antiretroviral therapy (HAART) during late pregnancy and during the first 6 months of lactation followed by early weaning can substantially reduce the risk of HIV-1 transmission among breast-feeding women. In addition it is anticipated that eligible HIV-1–infected nursing mothers in sub- Saharan Africa will increasingly be able to receive HAART for the maintenance of their own health. (excerpt)