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One way to stop babies being infected with HIV by their mothers is to give the babies antiretroviral therapy. Another way might be to curtail breast feeding but that is dangerous in developing countries. In Malawi (New England Journal of Medicine 2008;359:119–29; see also editorial, ibid: 189–91) a total of 3016 infants of HIV-1-infected, breast-feeding mothers were randomised at birth to three options. They were single-dose nevirapine plus 1 week of zidovudine (controls), control regimen plus daily nevirapine for a total of 14 weeks, or control regimen plus daily nevirapine and zidovudine to 14 weeks. Rates of HIV-1 infection at 6 weeks to 18 months of age were consistently higher in the control group. At 9 months the rates were 10.6% (controls), 5.2% (extended nevirapine) and 6.4% (extended nevirapine and zidovudine). In Zambia (ibid: 130–41) a total of 958 HIV-infected mothers were randomised to encouragement of abrupt weaning at 4 months (intervention group) or of continued breast feeding for as long as the mother wished to breast feed (control group). The proportions who had stopped breast feeding by 5 months were 69.0% vs 7.4%. The median duration of breast feeding was 4 months vs 16 months. Overall, 68.4% vs 64.0% survived to 24 months without HIV infection, a nonsignificant difference. Among children who were infected with HIV by 4 months, 24-month mortality was 73.6% (intervention) vs 54.8% (controls), a highly significant difference. Extended antiretroviral …
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