What Works for Women and Girls

of age. For breastfed infants, the only predictors of mother-to-child transmissionafter one month of age were high maternal viral load and low maternal CD4 count.Infant prophylaxis with zidovudine was not a significant predictor of transmission.No transmission was observed in breastfeeding mothers who had started treatmentwith HAART before delivery. Similarly, no transmission was observed in breastfeedingmothers who had viral loads of less than 3,500 copies/mL. Maternal treatmentwith single-dose nevirapine at delivery did not predict mother-to-child transmission(Shapiro et al., 2009). (Gray II) (PMTCT, breastfeeding, formula feeding, treatment,Botswana)The Post-Exposure Prophylaxis of Infants (PEPI) trial in Malawi found that extendedinfant prophylaxis with nevirapine or with nevirapine and zidovudine for the first14 weeks of life significantly reduced breast-feeding acquired HIV-1 infection in9-month-old infants. Between 2004 and 2007, 3016 breastfeeding infants wererandomly assigned to one of three different drug regimens. The control group receivedsingle-dose nevirapine plus one week of zidovudine, the second group received thecontrol regimen plus daily extended prophylaxis with nevirapine (extended nevirapinegroup) and the third group received the control regime plus nevirapine andzidovudine (extended dual prophylaxis group). At nine months (the primary endpoint in the study), the estimated rate of HIV-1 infection in the control group was10.6%. The extended nevirapine group had an infection rate of 5.2% and the extendeddual prophylaxis group had a rate of 6.4%. There were no significant differencesbetween the two extended prophylaxis groups although the extended dual prophylaxisgroup had a significant increase in the number of adverse events which were thoughtrelated to a study drug. This study demonstrated a protective efficacy of more than60% for the two extended prophylaxis groups at 14 weeks. Cumulative risk of postnatalinfection between birth and 14 weeks was 8.4% in the control group and 2.8%in the extended prophylaxis groups. This net difference of approximately 5% continuedat 24 months. (Kumwenda et al., 2008) (Gray II) (breastfeeding, treatment, PMTCT,Malawi)The Six Week Extended-Dose Nevirapine (SWEN) study combined study data from sitesin Ethiopia, India and Uganda to assess whether daily nevirapine given to breastfedinfants through six weeks of age would decrease HIV transmission from breastfeeding.HIV-positive women who were breastfeeding their infants were randomized to receiveeither single-dose nevirapine (during labor for the mother and after birth for the baby),or six week extended dose nevirapine (during labor for the mother and after birth for thebaby) plus daily nevirapine doses for the baby from day 8 to 42. The primary goal of thestudy was to assess HIV-infection rates at six months of age for infants who were HIVPCR negative at birth. The study concluded that a six week regimen of daily nevirapinemight be associated with a reduction in the risk of HIV transmission at six weeks ofage but the lack of a significant reduction of HIV transmission at the study end pointWHAT WORKS FOR WOMEN AND GIRLS255