WHO may change ARV guidelines for pregnant mothers

CAPE TOWN (Reuters) - International guidelines for mothers taking antiretrovirals (ARVs) may change, a senior WHO official said, with new evidence showing HIV infection rates among babies are significantly cut when mothers are given prolonged ARV treatment during breastfeeding.

The World Health Organization is reviewing its 2006 recommendations on the use of ARVs in pregnant women, including during the breastfeeding period. New guidelines are expected to be published by the end of 2009 and will take into account emerging data.

Results from a new study, conducted by WHO in partnership with a range of international agencies, were released at an international AIDS conference in Cape Town on Wednesday.

Key findings from the study showed that a stronger drug cocktail administered over a longer period reduced the risk of mother-to-child HIV transmission compared with the current WHO-recommended short-course ARV regimen.

“The results of this study show an almost two-fold reduction in the risk of HIV transmission during the breastfeeding period and also shows there is no short-term toxicity (to mothers or infants),” Dr Tim Farley, project leader for the “Kesho Bora” study, told Reuters on the conference sidelines on Tuesday.

The Kesho Bora study was conducted at five sites in Burkina Faso, Kenya and South Africa and saw 824 pregnant women enrolled to receive either a combination of three antiretroviral drugs -- zidovudine, lamivudine and lopinavir -- or the standard WHO-recommended short course regimen.

Farley said the combination drugs were administered from the last trimester of pregnancy and continued for a maximum of six months of breastfeeding.

“This is the first randomized trial to quantify the magnitude of the reduction in risk and shows that in the short term, certainly, it is safe.”

He said the results suggest that giving mothers the combination of ARVs during pregnancy, delivery and breastfeeding cut HIV infections in infants by 42 percent compared to current WHO recommendations.

Farley said the participants would be monitored to see if there were any long-term health side-effects. Results were expected to be released within a year’s time.

Farley, who works at WHO’s Department of Reproductive Health in Geneva, said another study in Malawi, using the same drug regimen showed similar reduction results.

“And that study also, interestingly, compared giving prophlyaxis to the baby, instead of giving prophlyaxis to the mother, and I think its going to be an interesting discussion at the guidelines process,” he said.

Health experts will have to weigh the different risks and benefits of giving mothers ARVs as opposed to administering the treatment to babies in a bid to reduce HIV transmission rates.

Reporting by Wendell Roelf; Editing by Giles Elgood