How should the twin PMTCT tools of maternal ART and infant prophylaxis be used during breastfeeding?
Stringer and Taha both argued that, for healthier women with higher CD4 cell counts, current evidence points to infant prophylaxis as the better intervention during breastfeeding – at least until there are more data from controlled trials. As described above, Taha found no significant prevention effect of maternal ART in these women. He also argued that, since antiretroviral drugs are absorbed into infant’s bodies by way of breast milk, there is the potential for excessive drug levels if infant prophylaxis and maternal ART are used simultaneously. Several larger prospective trials are currently examining these questions. The BAN (Breastfeeding, Antiretrovirals and Nutrition) study is a three-arm trial comparing extended infant prophylaxis and maternal ART to a control arm of short-course infant prophylaxis. The PROMISE study, a complex protocol with multiple randomisations, is comparing several prepartum ART regimens, postpartum HAART and infant prophylaxis, and continued versus termin
