What Works for Women and Girls

weeks of gestation and continued until six months after delivery. HAART was continuedbeyond six months if the mothers had CD4 cell counts that remained below 350. Incombination with HAART, nutritional supplements to mother and infant, patient counselingto increase adherence to breastfeeding and a strong network of support withinthe community led to the marked reduction of maternal and infant deaths (Marazzi etal., 2009). (Gray IV) (HAART, treatment, PMTCT, breastfeeding, Mozambique)A study enrolling HIV-positive pregnant women receiving a single dose of nevirapinefor preventing perinatal transmission of HIV during labor from 2003–2004 in Ugandafound that nevirapine was detectable in breast milk, maternal plasma, and infantplasma for 2–3 weeks after a single dose of maternal nevirapine. Overall, 62 womenwere included in the study. Sixty-one women received a single dose of nevirapine atleast 1.5 hours before delivery, and 53 women chose to breastfeed. All infants receiveda single dose of nevirapine syrup within 72 hours of birth. Samples of breast milk andplasma from both mothers and infants were taken 1, 2, and 6 weeks after maternal nevirapinetreatment. Infant plasma levels of nevirapine at delivery were correlated with thetiming of maternal nevirapine intake. Infant nevirapine levels were the highest approximately4 hours after maternal nevirapine intake, after which infant treatment with nevirapineonly slightly increased infant nevirapine plasma concentrations. Furthermore,nevirapine transferred from maternal plasma to breast milk rapidly, and nevirapine inbreast milk was detectable before infants initiated breastfeeding. The long-term durationof nevirapine in breast milk was determined to be protective against postnataltransmission due to the effective suppression of HIV in breast milk for up to 3 weeksafter maternal single dose nevirapine intake. However, the long-term duration of nevirapinealso increases the risk for nevirapine resistance mutation development, and theacquisition of a resistant virus for infants. Because the risk of nevirapine resistancedecreases over time, infants are most at risk for acquiring a resistant virus during theinitial breastfeeding period. Extended antiretroviral treatment with zidovudine/lamivudineshould therefore be considered to reduce the risk of nevirapine resistance (Kunz etal., 2009). (Gray IV) (PMTCT, treatment, breastfeeding, Uganda) [See introduction of 9C-2.Treatment for discussion of nevirapine resistance]Lower maternal CD4 count was associated with a significantly higher risk of transmissionthrough breastfeeding (Mofeson et al., 1999 cited in Abrams et al., 2007), thereforeHAART, by increasing CD4 counts can reduce transmission of HIV during breastfeeding(Abrams et al., 2007). (Gray V) (CD4 counts, breastfeeding, HAART, PMTCT)The Breastfeeding, Antiretroviral and Nutrition (BAN) Study is a randomized trial inMalawi that evaluated rates of post-natal HIV-1 transmission among mother infant pairswho received single dose nevirapine intrapartum and one week of twice-daily zidovudine/lamivudinefollowed by randomization into three ARV treatment groups. Thedosing above served as the control group. Among 2637 mother-infant pairs, in uterotransmission was estimated at 4.9% (measured at one week). Estimated risk of HIVWHAT WORKS FOR WOMEN AND GIRLS257