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Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels.

Maternal Highly Active Antiretroviral Therapy Reduces Vertical Cytomegalovirus Transmission But Does Not Reduce Breast Milk Cytomegalovirus Levels.
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Slyker JA, Richardson B, Chung MH, Atkinson C, Ásbjörnsdóttir KH, Lehman DA, Boeckh M, Emery V, Kiarie J, John-Stewart G,


Slyker JA, Richardson B, Chung MH, Atkinson C, Ásbjörnsdóttir KH, Lehman DA, Boeckh M, Emery V, Kiarie J, John-Stewart G, (click to view)

Slyker JA, Richardson B, Chung MH, Atkinson C, Ásbjörnsdóttir KH, Lehman DA, Boeckh M, Emery V, Kiarie J, John-Stewart G,

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AIDS research and human retroviruses 2016 12 06()

Abstract
OBJECTIVE
To evaluate the impact of highly active antiretroviral therapy (HAART) on CMV transmission and breast milk level in the context of maternal HIV.

DESIGN
Specimens from a randomized trial conducted in Nairobi, Kenya between 2003-2005 were used to compare CMV transmission and breast milk levels between mother-infant pairs randomized to HAART versus short-course antenatal zidovudine plus single-dose nevirapine (ZDV/sdNVP) for prevention of mother-to-child HIV transmission (PMTCT).

METHODS
Fifty-one antiretroviral-naïve women ≤32 weeks gestation, and CD4 between 200-500 cells/mm(3) were randomized at 34 weeks to begin either antenatal ZDV/sdNVP, or HAART through 6 months postpartum. Mean breast milk CMV levels and transmission were compared between arms.

RESULTS
Age, sociodemographics, CD4%, and HIV plasma RNA viral load were similar between arms at baseline. CMV viral loads were measured from 243 infant plasma and 185 breast milk specimens during the first year postpartum. The probability of infant CMV infection at 12 months was 19% lower in the HAART arm compared to ZDV/sdNVP (75% vs. 94%, p = .04). All women had CMV detected in breast milk, with 72%, 98%, and 97% testing positive during the first, second, and third weeks postpartum, respectively. There was a trend for early higher mean breast milk CMV level in the HAART arm at 1 week (p = .08), and there was significantly slower decline in breast milk CMV levels (area under the curve, p = .01).

CONCLUSIONS
HAART started during the third trimester may decrease infant CMV infections, by mechanisms independent of breast milk CMV levels.

CLINICAL TRIALS REGISTRATION
NCT00167674.

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