AMATA Study

AMATA study: effectiveness of antiretroviral therapy in breastfeeding mothers to prevent post-natal vertical transmission in Rwanda

by : Centre Hospitalier de Luxembourg, Luxembourg ; Lux-Development Project INT/107, Kigali, Rwanda ; Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda ; Treatment and Research on AIDS Centre, Kigali, Rwanda.

Amata: Allaitement Maternal sous Trithérapie Antirétrovirale, also “milk” in Kinyarwanda

Background: Vertical transmission of HIV-1 occurs pre-natal at birth, and post-natal via breast-feeding. Approximately 15% of children born to HIV-infected mothers acquire HIV as a result of breast-feeding. Alternatives to breast-feeding in HIV-infected women include use of formula. Antiretroviral therapy (ART) may also be combined with breast-feeding. Independent of the HIV infection risk, breast-feeding provides benefits to children’s health, lost to formula-fed children. The AMATA study explores the impact of breast-feeding plus maternal HAART vs. formula feeding in terms of vertical transmission and child morbidity, mortality, as well as its development.

Objectives: Vertical transmission through breastfeeding remains a major problem in developing countries. The study compares triple antiretroviral therapy (ART) given to breastfeeding (BF) mothers with formula feeding (FF) for prevention of post-natal mother-to-child transmission.

Methods: All HIV-1 infected women followed at 4 antenatal care sites in Kigali were offered to participate in the study. All received NNRTI-based HAART starting after the second trimester of pregnancy. Women were given the choice between FF and BF with weaning at 6 months. The latter group continued ART until 1 month after the end of BF.

Results: 572 women were enrolled. 528 children were born as of March 1, 2007. 304 mothers (58%) opted for FF while 224 (42%) chose BF under ART. Diagnostic PCR is so far available for 419 babies at 6 weeks of age and for 236 at 7 months of age. Among these, 6 children are infected with HIV (1,4%). All 6 had a positive PCR (Polymerase Chain Reaction) already at birth and, among those tested so far, none has become infected through breastfeeding under ART. Psychomotor development was assessed at different time intervals and the team found no difference between BF and FF children. No significant difference in morbidity was observed either. The difference in mortality was not significant: 9 children under FF died (2,9%), compared to 3 (1,3%) under BF (p=0,12).

Conclusions: Breastfeeding under triple antiretroviral therapy in children born to HIV-1 infected mothers is a safe way of avoiding HIV-1 infection in the baby while keeping the benefits of breastfeeding and avoiding the stigmatisation and risks of artificial feeding.

Authors: Arendt V., Ndimubanzi P., Vyankandondera J., Ndayisaba G., Muganda j., Courteille O., Rutanga C., Havuga E., Dhont N., Mujawamassiga A., Omes C., Peltier A.