Observational studies and randomized clinical trials demonstrating that antiretroviral prophylaxis of the breastfeeding infant or triple-drug antiretroviral prophylaxis of the lactating mother can significantly affect the risk of postnatal transmission of HIV via breast milk have recently become available. In resource-limited countries, breastfeeding is a cornerstone of infant survival. While shortening the duration of breastfeeding by HIV-infected women reduces postnatal HIV transmission, increasing data suggest this may also decrease overall infant survival. Thus, there is a crucial need for interventions to allow safer and more prolonged breastfeeding. This paper will critically review the results of studies of postnatal antiretroviral prophylaxis to prevent breast milk HIV transmission.
CoovadiaH.M., RollinsN.C., BlandR.M.Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study.Lancet2007; 369: 1107–1116.
3.
KuhnL., SinkalaM., KankasaC.High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission.PLoS ONE2007; 2: e1363.
4.
TownsendC.L., Cortina-BorjaM., PeckhamC.S., de RuiterA., LyallH., TookeyP.A.Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006.AIDS2008; 22: 973–981.
WHO.Towards universal access: scaling up priority HIV/ AIDS interventions in the health care sector: progress report 2009.Geneva: WHO2009. (Updated 3 November 2009. Accessed 4 May 2010.) Available from http://data.unaids.org/pub/Report/2009/20090930_tuapr_2009_en.pdf.
7.
WHO.Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants in resource-limited settings; towards universal access: recommendations for a public health approach – 2006 version.Geneva: WHO2006.
8.
WHO.Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents – November 2009.Geneva: WHO2009. (Updated 23 February 2010. Accessed 4 May 2010.) Available from http://www.who.int/hiv/pub/arv/rapid_advice_art.pdf.
9.
WHO.Rapid advice: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants – November 2009.Geneva: WHO2009. (Updated 23 March 2010. Accessed 4 May 2010.) Available from http://www.who.int/hiv/pub/mtct/rapid_advice_mtct.pdf.
10.
SevereP., PapeJ., FitzgeraldD.W.A randomized clinical trial of early versus standard antiretroviral therapy for HIV-infected patients with a CD4 T cell count of 200–350 cells/ml (CIPRAHT001).Interscience Conference on Antimicrobial Agents and Chemotherapy. 12–15 September 2009, San Francisco, CA, USA. Abstract H-1230c.
11.
MmiroF.A., AizireJ., MwathaA.K.Predictors of early and late mother-to-child transmission of HIV in a breastfeeding population: HIV Network for Prevention Trials 012 experience, Kampala, Uganda.J Acquir Immune Defic Syndr2009; 52: 32–39.
12.
BecquetR., EkoueviD.K., ArriveE.Universal antiretroviral therapy for pregnant and breast-feeding HIV-1-infected women: towards the elimination of mother-to-child transmission of HIV-1 in resource-limited settings.Clin Infect Dis2009; 49: 1936–1945.
13.
MofensonL.M., TahaT.E., QingL.Infant extended antiretroviral (ARV) prophylaxis is effective in preventing postnatal mother to child HIV transmission (MTCT) at all maternal CD4 vounts.5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. 12–22 July 2009, Capetown, South Africa. Abstract TuPEC053.
14.
ChaselaC., ChenY.Q., FiscusS.Risk factors for late postnatal transmission of human immunodeficiency virus type 1 in sub-Saharan Africa.Pediatr Infect Dis J2008; 27: 251–256.
15.
The Breastfeeding and HIV International Transmission Study Group.Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis.J Infect Dis2004; 189: 2154–2166.
16.
KuhnL., AldrovandiG., SinkalaM.Potential impact of new World Health Organization criteria for antiretroviral treatment for prevention of mother to child HIV transmission.AIDS2010; 24: 1374–1377.
17.
BrownE.R., OtienoP., Mbori-NgachaD.A.Comparison of CD4 cell count, viral load and other markers for prediction of mortality among HIV-1-infected Kenyan pregnant women.J Infect Dis2009; 199: 1292–1300.
18.
DuganK., CarterR., ToroP.Comparing clinical and immunologic criteria for determining HAART eligibility among HIV-infected pregnant and postpartum women in low resource settings.1st International Workshop on HIV Pediatrics. 17–18 July 2009, Capetown, South Africa. Abstract O15.
19.
EkoueviD.K., InwoleyA., Tonwe-GoldB.Variation of CD4 count and percentage during pregnancy and after delivery: implications for HAART initiation in resource-limited settings.AIDS Res Hum Retroviruses2007; 23: 1469–1474.
20.
ThiorI., LockmanS., SmeatonL.M.Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study.JAMA2006; 296: 794–805.
21.
KilewoC., KarlssonK., MassaweA.Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra Study.J Acquir Immune Defic Syndr2008; 48: 315–323.
22.
VyankandonderaJ., LuchtersS., HassinkE.SIMBA – Stopping Infection from Mother to Child via Breastfeeding in Africa.3rd International AIDS Society Conference on HIV Pathogenesis. 24–27 July 2003, Paris, France. Abstract LB07.
23.
Six Week Extended-Dose Nevirapine (SWEN) Study Team.Extended-dose nevirapine to 6 weeks of age for infants to prevent HIV transmission via breastfeeding in Ethiopia, India, and Uganda: an analysis of three randomised controlled trials.Lancet2008; 372: 300–313.
ChaselaC.S., HudgensM.G., JaimesonD.J.Maternal or infant antiretroviral drugs to reduce HIV-1 transmission.N Engl J Med2010; 362: 2271–2281.
26.
MarazziC.M., GermanoP., LiottaG.Implementing antiretroviral triple therapy to prevent HIV mother-to-child transmission: a public health approach in resource-limited settings.Eur J Pediatr2007; 166: 1305–1307.
27.
PalombiL., MarazziM.C., VoetbergA., MagidN.A.Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV.AIDS2007; 21 Suppl 4: S65–S71.
28.
ThomasT., MasabaR., NdivoR.Prevention of mother-to-child transmission of HIV-1 among breastfeeding mothers using HAART: the Kisumu Breastfeeding Study, Kisumu, Kenya, 2003–2007.14th Conference on Retroviruses and Opportunistic Infections. 3–6 February 2008, Boston, MA, USA. Abstract 45aLB.
29.
KilewoC., KarlssonK., NgarinaM.Prevention of mother-to-child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the MITRA PLUS Study.J Acquir Immune Defic Syndr2009; 52: 406–416.
30.
PeltierC.A., NdayisabaG.F., LepageP.Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother to child infection in Rwanda.AIDS2009; 23: 2415–2423.
31.
de VincenziI., the Kesho Bora Study Group. Triple-antiretroviral prophylaxis during pregnancy and breastfeeding compared to short-ARV prophylaxis to prevent mother-to-child transmission of HIV-1: the Kesho Bora randomized controlled clinical trial in five sites in Burkina Faso, Kenya and South Africa.5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. 19–22 July 2009, Cape Town, South Africa. Abstract LBPE C01.
32.
ShapiroR.L., HughesM.D., OgwuA.Antiretroviral regimens in pregnancy and breastfeeding in Botswana.N Engl J Med2010; 362: 2282–2294.
33.
WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality.Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis.Lancet2000; 355: 451–455.
34.
MacleanC.C., StringerJ.S.A.Potential cost-effectiveness of maternal and infant antiretroviral interventions to prevent mother-to-child transmission during breastfeeding.J Acquir Immune Defic Syndr2005; 38: 570–577.
35.
EkoueviD.K., CoffieP.A., BecquetR.Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Côte d'Ivoire.AIDS2008; 22: 1815–1820.
36.
Van der MerweK., ChersichM., BlackV.The impact of in-utero antiretroviral therapy (ART) exposure on infant outcomes in Johannesburg, South Africa.5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. 19–22 July 2009, Cape Town, South Africa. Abstract WePE B262.
37.
TownsendC.L., Cortina-BorjaM., PeckhamC.S., TookeyP.A.Antiretroviral therapy and premature delivery in diagnosed HIV-infected women in the United Kingdom and Ireland.AIDS2007; 21: 1019–1026.
38.
KourtisA.P., SchmidC.H., JamiesonD.J., LauJ.Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis.AIDS2007; 21: 607–615.
39.
MoorthyA., GuptaA., BhosaleR.Nevirapine resistance and breast-milk HIV transmission: effects of single and extended-dose nevirapine prophylaxis in subtype C HIV-infected infants.PLoS ONE2009; 4: e4096.
40.
LidstromJ., LiQ., HooverD.R.Addition of extended zidovudine to extended nevirapine prophylaxis reduces nevirapine resistance in infants who were HIV-infected in utero.AIDS2010; 24: 381–386.
41.
ZehC., WeidleP., NafisaL.Emergence of HIV-1 drug resistance among breastfeeding infants born to HIV-infected mothers taking antiretrovirals for prevention of mother-to-child transmission of HIV: the Kisumu Breastfeeding Study, Kenya.15th Conference on Retroviruses and Opportunistic Infections. 3–6 February 2008, Boston, MA, USA. Abstract 84LB.
42.
LidstromJ., KumwendaN., KafulafulaG.Antiretroviral treatment of HIV-infected women can induce multi-class drug resistance in their breastfeeding infants.Antivir Ther2009; 14 Suppl 1: A158.
43.
LidstromJ., GuayL., MusokeP.Multi-class drug resistance arises frequently in HIV-infected breastfeeding infants whose mothers initiate HAART postpartum.17th Conference on Retroviruses and Opportunistic Infections. 16–19 February 2010, San Francisco, CA, USA. Abstract 920.
44.
MirochnickM., ThomasT., CapparelliE.Antiretroviral concentrations in breast-feeding infants of mothers receiving highly active antiretroviral therapy.Antimicrob Agents Chemother2009; 53: 1170–1176.
45.
ColebundersR., HodossyB., BurgerD.The effect of highly active antiretroviral treatment on viral load and antiretroviral drug levels in breast milk.AIDS2005; 19: 1912–1915.
46.
KuhnL., AldrovandiG.M., SinkalaM.Effects of early, abrupt weaning on HIV-free survival of children in Zambia.N Engl J Med2008; 359: 130–141.
47.
KafulafulaG., HooverD., TahaT.E.Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-infected women in Malawi.J Acquir Immune Defic Syndr2010; 53: 6–13.
48.
HomsyJ., MooreD., BarasaA.Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to hiv-infected women on highly active antiretroviral therapy in rural Uganda.J Acquir Immune Defic Syndr2010; 53: 28–35.
49.
ThomasT., MasabaR., van EijkA.Rates of diarrhoea associated with early weaning among infants in Kisumu, Kenya.14th Conference on Retroviruses and Opportunistic Infections. 3–6 February 2008, Boston, MA, USA. Abstract 774.
50.
CreekT.L., KimA., LuL.Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006.J Acquir Immune Defic Syndr2010; 53: 14–19.
51.
WHO.Rapid advice: infant feeding in the context of HIV – November 2009.Geneva: WHO2009. (Updated 30 November 2009. Accessed 4 May 2010.) Available from http://www.who.int/hiv/pub/paediatric/advice/en.
