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A pooled analysis of individual data from >5000 human immunodeficiency virus type 1 (HIV-1)–infected mothers and their infants from Africa and India who participated in 5 randomized trials shows that extended prophylaxis with nevirapine or with nevirapine and zidovudine significantly reduces postnatal HIV-1 infection.Background. In resource-limited settings, mothers infected with human immunodeficiency virus type 1 (HIV-1) face a difficult choice: breastfeed their infants but risk transmitting HIV-1 or not breastfeed their infants and risk the infants dying of other infectious diseases or malnutrition. Recent results from observational studies and randomized clinical trials indicate daily administration of nevirapine to the infant can prevent breast-milk HIV-1 transmission.Methods. Data from 5396 mother-infant pairs who participated in 5 randomized trials where the infant was HIV-1 negative at birth were pooled to estimate the efficacy of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission. Four daily regimens were compared: nevirapine for 6 weeks, 14 weeks, or 28 weeks, or nevirapine plus zidovudine for 14 weeks.Results. The estimated 28-week risk of HIV-1 transmission was 5.8% (95% confidence interval [CI], 4.3%–7.9%) for the 6-week nevirapine regimen, 3.7% (95% CI, 2.5%–5.4%) for the 14-week nevirapine regimen, 4.8% (95% CI, 3.5%–6.7%) for the 14-week nevirapine plus zidovudine regimen, and 1.8% (95% CI, 1.0%–3.1%) for the 28-week nevirapine regimen (log-rank test for trend, P < .001). Cox regression models with nevirapine as a time-varying covariate, stratified by trial site and adjusted for maternal CD4 cell count and infant birth weight, indicated that nevirapine reduces the rate of HIV-1 infection by 71% (95% CI, 58%–80%; P < .001) and reduces the rate of HIV infection or death by 58% (95% CI, 45%–69%; P < .001).Conclusions. Extended prophylaxis with nevirapine or with nevirapine and zidovudine significantly reduces postnatal HIV-1 infection. Longer duration of prophylaxis results in a greater reduction in the risk of infection. [ABSTRACT FROM AUTHOR]

In the present study, concentrations of organochlorine pesticide residues viz. Dichlorodiphenyltrichloroethane and its metabolites (DDTs) and Hexachlorocyclohexane isomers (HCHs) in human breast milk and human blood samples, collected from several high altitude regions of Garhwal Himalaya in Uttarakhand, India viz. Devprayag, Chamoli, Uttarkashi, Joshimath, Bhatwari and Gangnani (altitude ranging from 472 to 1,982 m above sea level) were determined. Mean concentrations of HCH and DDT in human milk samples ranged from 4.53 to 34.32 mg/kg and 6.09 to 12.98 mg/kg, respectively. While the human blood showed mean values ranging from 6.64 to 281.7 μg/L and 12.37 to 104.10 μg/L for HCH and DDT, respectively. The study showed much higher concentrations of organochlorine residue contamination in the Garhwal region as compared to other parts of India. Risk assessments for infants were also calculated and were found within WHO limits. [ABSTRACT FROM AUTHOR]

Lead levels in human breast milk and blood plasma or serum were analyzed and qualitatively their intelligence quotient (I.Q.) studied. Samples at different stages of lactation, from 5 days to 51 weeks post partum, were collected from 25 healthy breast-feeding mothers in Ranipet Industrial area of Vellore district of Tamil Nadu and from 25 lactating mothers in the non-industrial areas of the same district. The samples from mothers in non-industrial area showed lower lead levels ranging from 5 to 25 μg/L whereas samples from mothers in industrial area showed higher lead levels ranging between 15 and 44.5 μg/L. It was generally noticed that the lactating mothers from industrial area have lower I.Q. levels compared to mothers from non-industrial area. [ABSTRACT FROM AUTHOR]

Abstract: Despite the worldwide ban on use of persistent organochlorine pesticides, their usage continued until recently in India, for vector-borne disease eradication programs and agricultural purposes. The concentrations of organochlorine contaminants, DDT and HCH, have been determined in human breast milk from Dibrugarh and Nagaon districts of Assam state, North-East India. The results demonstrated that the mean levels of total DDT were 3210ng/g lipid wt. and 2870ng/g lipid wt. and total HCH were 2720ng/g lipid wt. and 2330ng/g lipid wt. in Nagaon and Dibrugarh respectively. There was no significant difference in the levels of investigated pollutants between the two districts. Significant differences in ADI (Average daily intake) for total DDT were found between the two districts. In addition, a positive correlation was observed between OCP levels in breast milk and age of mothers. Based on OCP levels in human breast milk, the ADI by the infants has been estimated. It has been found that high daily intake of DDTs and HCHs by the infants exceeded the TDI (Tolerable daily intake) which implied that infants of the region are potentially at high risk by these contaminants. [Copyright &y& Elsevier]

Background: Daily nevirapine (NVP) prophylaxis to HIV-exposed infants significantly reduces breast-milk HIV transmission. We assessed NVP-resistance in Indian infants enrolled in the ''six-week extended-dose nevirapine'' (SWEN) trial who received single-dose NVP (SD-NVP) or SWEN for prevention of breast-milk HIV transmission but who also acquired subtype C HIV infection during the first year of life. Methods/Findings: Standard population sequencing and cloning for viral subpopulations present at $5% frequency were used to determine HIV genotypes from 94% of the 79 infected Indian infants studied. Timing of infection was defined based on when an infant's blood sample first tested positive for HIV DNA. SWEN-exposed infants diagnosed with HIV by six weeks of age had a significantly higher prevalence of NVP-resistance than those who received SD-NVP, by both standard population sequencing (92% of 12 vs. 38% of 29; p = 0.002) and low frequency clonal analysis (92% of 12 vs. 59% of 29; p = 0.06). Likelihood of infection with NVP-resistant HIV through breast-milk among infants infected after age six weeks was substantial, but prevalence of NVP-resistance did not differ among SWEN or SD-NVP exposed infants by standard population sequencing (15% of 13 vs. 15% of 20; p = 1.00) and clonal analysis (31% of 13 vs. 40% of 20; p = 0.72). Types of NVP-resistance mutations and patterns of persistence at one year of age were similar between the two groups. NVPresistance mutations did differ by timing of HIV infection; the Y181C variant was predominant among infants diagnosed in the first six weeks of life, compared to Y188C/H during late breast-milk transmission. Conclusions/Significance: Use of SWEN to prevent breast-milk HIV transmission carries a high likelihood of resistance if infection occurs in the first six weeks of life. Moreover, there was a continued risk of transmission of NVP-resistant HIV through breastfeeding during the first year of life, but did not differ between SD-NVP and SWEN groups. As with SD-NVP, the value of preventing HIV infection in a large number of infants should be considered alongside the high risk of resistance associated with extended NVP prophylaxis. [ABSTRACT FROM AUTHOR]