Maternal or Infant Antiretroviral Drugs to Reduce HIV-1 Transmission

There is a critical need for effective highly active antiretroviral therapy (HAART) to prevent mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in low-resource areas of the world where replacement feeding is not feasible. The most effective HAART regimen to prevent HIV transmission during breast-feeding is unknown.This study compared different HAART regimens to determine whether they differ with respect to virologic suppression during pregnancy and breast-feeding, pregnancy outcomes, and adverse effects in mothers and infants. The participants—560 pregnant HIV-1 infected women with CD4+ cell counts of ≥200—were randomly assigned to receive either a coformulation of abacavir, zidovudine, and lamivudine (the nucleoside reverse-transcriptase inhibitor [NRTI] group) or a coformulation of lopinavir-ritonavir plus zidovudine-lamivudine (the protease inhibitor group). Both the regimens were administered between 26 and 34 weeksʼ gestation and were continued through planned weaning by 6 months postpartum. The observational group—170 women with CD4+ cell counts