Interventions for preventing late postnatal mother-to-child transmission of HIV

Global Health Sciences, University of California, San Francisco, Box 1224, San Francisco, California 94143, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 01/2009; 1(1):CD006734. DOI: 10.1002/14651858.CD006734.pub2
Source: PubMed


Mother-to-child transmission (MTCT) of HIV is the primary way that children become infected with HIV. Such transmission can take place when the child is still in the mother’s womb, around the time of birth, or through breastfeeding after birth. Hundreds of thousands of children are infected this way every year, with most of them in developing countries. Major progress has been made in preventing MTCT when the baby is still in the mother’s womb, or around the time the baby is born. In many resource-rich settings, mothers with HIV infection are counseled not to breastfeed their children, and there are feasible and affordable alternatives to breastfeeding. However, in parts of the world where the vast majority of mothers with HIV infection live, complete avoidance of breastfeeding is often not feasible (for example, because of the lack of availability of clean water and of affordable replacement feeding). Therefore, interventions to prevent transmission of HIV infection through breast milk are urgently needed. The authors found that, in addition to complete avoidance of breastfeeding if safe and affordable, exclusive breastfeeding (where the baby receives only breast milk) for the first few months of life helps prevent transmission (as compared to breastfeeding supplemented by feeding the baby other liquids or solids). Another intervention, giving the baby an anti-HIV medicine (antiretroviral) while breastfeeding, decreases the risk of transmission of HIV from mother to child. Implementation of such interventions, as well as developing more and better interventions, is essential.

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    • "also found to reduce the amount of HIV-1 shedding in genital secretions (Graham et al. 2007) leading to lower sexual transmission (Attia et al. 2009). Mother to child HIV transmission during pregnancy, delivery, or breastfeeding was intervened with HAART and till date PMTCT remained one of the most successful HIV preventive strategies globally (Rutenberg et al. 2003, Horvath et al. 2009, Doherty et al. 2003). The success of ART inspired the idea that PrEP with HAART could be effective for HIV prevention (Baird et al. 2003). "
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    ABSTRACT: Antiretroviral drugs are being tried as candidates for the pre-exposure prophylaxis (PrEP) against HIV for a considerable period, due to their potential for immediate inhibition of viral replication. Discrepancies in the findings called for a critical review of the relevant efforts and their outcomes. A systematic literature search identified 143 eligible articles of which only 5 reported complete findings while another 11 were still on-going. Observed moderate efficacy and good safety profile seemed to identify PrEP as a promising step for minimizing the spread of HIV to relatively unaffected population and controlling the epidemic among high risk population groups. But the duration of this efficacy was found to depend heavily on the availability, adherence and other related issues like cost, political commitment, ethical consideration etc. To prevent potential cultural and behavioral modifications, proper pre-administration counseling also seemed critical for the success of PrEP as a cost-effective intervention with adequate coverage.
    Artificial Cells 07/2014; DOI:10.3109/21691401.2014.934458 · 1.02 Impact Factor
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    • "In combination with prenatal HIV testing, antiretroviral therapy (ART) for mother and newborn, and caesarean section delivery, formula feeding has decreased rates of vertical transmission of HIV to less than 1% (Horvath et al., 2009). A systematic review by Horvath and colleagues (2009) demonstrates that breastfeeding almost doubles the risk of HIV transmission from 21% in formula-fed infants to 37% in infants who were exclusively breastfed (Horvath et al., 2009). In settings where access to clean water for infant formula cannot be guaranteed, practice guidelines have balanced HIV prevention with meeting the nutritional requirements of the infant while ensuring protection against non-HIV morbidity and mortality (WHO, 2010). "
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    ABSTRACT: ABSTRACT Infant feeding raises unique concerns for mothers living with HIV in Canada where they are recommended to avoid breastfeeding yet live in a social context of "breast is best." In narrative interviews with HIV-positive mothers from across Ontario, Canada a range of feelings regarding not breastfeeding was expressed balancing feelings of loss and self-blame with the view of responsibility and "good mothering" under the current Canadian guidelines. Acknowledging responsibility to put their child's health first, participants revealed their choices were influenced by variations in social and cultural norms, messaging and guidelines regarding breastfeeding across geographical contexts. This qualitative study raises key questions about the impact of breastfeeding messaging and guidelines for HIV-positive women in Canada.
    Health Care For Women International 02/2014; 36(8). DOI:10.1080/07399332.2014.888720 · 0.63 Impact Factor
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    • "Cessation of breastfeeding is impractical at an early stage for social, financial and hygienic reasons in low income settings [45,46]. It has been suggested to shorten the period of breastfeeding while continuing to administer preventive antiretroviral drugs to both the mother and uninfected infant in order to attain the maximum benefit [17]. "
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    ABSTRACT: Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme. A 1:1 unmatched case-control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status. A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective. HIV infection among children increased if the mother's CD4 count was <=200 cells/muL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.
    BMC Public Health 12/2013; 13(1):1181. DOI:10.1186/1471-2458-13-1181 · 2.26 Impact Factor
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