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Breastfeeding With HIV

New Research May Make It Safer For HIV Positive Moms to Breastfeed

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Updated July 17, 2008

Breastfeeding continues to be one of the primary routes of HIV transmission in the developing world. The World Health Organization (WHO) estimates that 150,000 babies around the world are infected via breastfeeding each year. In the western world, including the United States, the risk associated with breastfeeding has a lesser impact because other options exist, namely commercially available baby formulas and access to clean water. In addition, scientists have worked extensively to develop methods of decreasing the risk of mother to child HIV transmission. And thus far their work is paying off. In the 1990's in resource rich countries like the US, the rate of mother to child transmission was around 15-25 cases per 100 people. Now with all the strides that have been made in the prevention of mother to child transmission that rate is now about 2 in 100.

But in developing countries like many countries in Africa, breastfeeding is the only option for moms due to limited resources, hard to obtain commercial baby formula, clean water and issues with stigma. Add to that the fact that women have limited access to HIV medications and are therefore more likely to transmit HIV to their newborn child. Before HIV treatment the rate of mother to child transmission in these countries was upwards of 40 per 100 people. So despite the risk, HIV positive moms in developing countries continue to breastfeed out of necessity and in doing so babies continue to get infected.

But there are ongoing efforts toward risk reduction for these moms and their babies. Research is providing evidence that the risk of HIV transmission during breastfeeding can be reduced for HIV positive moms.

Antiretroviral Therapy Makes Breastfeeding Safer

In an effort to prevent HIV transmission from mother to newborn child, there are medication regimens given to mom during pregnancy, during delivery, and given to the baby after delivery. These medications work to decrease the mother's HIV viral load and in fact some of these medications can be passed to baby via breastfeeding and in doing so decrease the baby's risk of being infected. In resource-rich countries where medications are readily available, these regimens are typically multidrug combinations. In developing countries where medications and resources for medications are scarce, typically, one dose of Viramune (neverapine) is given to the mother during delivery and another dose to the child after delivery to decrease the risk of HIV infection.

Preventing Transmission from Mother to Newborn While Breastfeeding

Researchers from John's Hopkins University report that an extended Viramune regimen study (SWEN) shows that Viramune given to infants once per day for 42 days after delivery compared with one single dose after delivery decreases transmission via breastfeeding by one half at 6 weeks of age. Though this benefit was no longer appreciated at 6 months, the data did show a significantly lower mortality rate at 6 months when compared to single dose Viramune. In addition, the once daily dose appears to be as safe as the single dose.

These findings are very significant especially in the developing countries where breastfeeding is the primary source of HIV infection among children and where alternatives to breastfeeding may fail to be feasible, affordable, sustainable, safe, and acceptable options. Because once daily Viramune is readily available in most parts of the world, it is a viable option for those children that have no other choice but to breastfeed.

What Else Does The Data Tell us?

The research findings are significant in more ways than just protection during breastfeeding. The study is one of the first to show antiretrovirals can be used to prevent HIV transmission via mucosal tissue. This could have a significant impact on HIV prevention especially in parts of the world where condoms and prevention education is scarce.

Source
Johns Hopkins University; "Breastfeeding Now Safer For Infants Of HIV-infected Mothers"; Science Daily; 5 Feb 2008.

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