Kesho Bora study: Maternal antiretroviral therapy during pregnancy and breastfeeding prevents more infections than short-course prophylaxis

July 2009

The Kesho Bora study in Kenya, South Africa, and Burkina Faso investigated whether giving highly active anti-retroviral therapy (HAART) to women with CD4 counts between 200 and 500 cells/mm3 during pregnancy, labor, and through six months of breastfeeding reduced vertical HIV transmission compared to short-course therapy from weeks 28 to 36 through one week after delivery. Investigators found no difference in transmission rates from birth through the first week of life, but did find a significant reduction in risk of transmission by one year of age in the HAART group. Sub-group analysis showed that the significant difference was confined to women with CD4 counts between 200 and 350 cells/μL. Among those women, the HIV transmission rate at 12 months was 6.1% in the HAART group, compared to 11.1% in the short-course group. The HIV-free survival rate for the entire HAART group was 89.6% at 12 months compared to 83.7% in the short-course group, indicating a 36% risk reduction with HAART. 

Among women who received HAART and had CD4 counts less than 200 cells/μL, risk of death or HIV was 26.7% among infants who were never breastfed compared to 10.8% if they were breastfed. This finding suggests that treatment for eligible women plus breastfeeding provides the best protection for HIV-exposed infants.

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