January 31, 2011
H.I.V.: Drugs Often Reserved for the Very Sick May Stem Mother-to-Baby Infections
By DONALD G. McNEIL Jr.

Breast-feeding mothers infected with the virus that causes AIDS can pass it along to their babies. But this is much less likely if the women receive antiretroviral triple therapy, according to a new study — even when they are not yet sick enough to qualify for it.

In the study, published by The Lancet this month, researchers followed 805 mothers and newborns in three African countries from midpregnancy to the end of breast-feeding. (It is common for babies in Africa to be breast-fed for many months, and water and other foods may irritate the gut and increase the risk of infection.)

All the women were infected with H.I.V., but none were close to full-blown AIDS, so they would not normally qualify for triple therapy in poor countries where health ministries are forced to choose who gets the drugs and who doesn’t.

For the study, half were given triple therapy until breast-feeding ended, and half got the standard, cheaper treatment: daily doses of AZT for a few weeks before labor, a single dose of nevirapine at birth for both mother and baby, plus two drugs for a week after the birth.

After a year, the mothers getting triple therapy were 43 percent less likely to have infected their babies.

Even before publication, the study led the World Health Organization to revise its guidelines to encourage triple therapy for pregnant women. But with donor money shrinking, not all poor countries can offer it.

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