Prevention of HIV transmission through breastfeeding

Prevention of HIV transmission through breastfeeding
Fatemeh Imani,^1,* Fatemeh Kermani,²
1. Member of Omid research group of Bushehr University of Medical Sciences, Bushehr, Iran
2. Member of Omid research group of Islamic Azad University, Mashhad Branch, Mashhad, Iran.
Introduction: Acquired immunodeficiency syndrome (AIDS) is a disease caused by the human immunodeficiency virus (HIV). The majority of childhood infections are acquired through mother-to-child transmission (MTCT) during pregnancy, labor, delivery, and breastfeeding. Prevention of mother to child transmission (PMTCT) through breastfeeding by effective strategies is an important subject in debates. We summarized the strategies shown to have efficacy on PMTCT through breastfeeding.
Methods: The literature search was performed using the Pubmed, Google Scholar, and Science direct databases between 2010 to 2020 by the combination of terms: ” prevention”, “breastfeeding” and “HIV” as keywords. In all 64 results, 10 related articles were selected. Duplicate and unrelated cases that discussed other issues were excluded.
Results: 1. It was recommended that mothers living with HIV should breastfeed for at least 12 months while maternal combination antiretroviral therapy (cART) and prophylaxis for infants are provided during the whole duration of breastfeeding. 2. It was shown that exclusive breastfeeding during the first six months is associated with a lower risk of MTCT than mixed feeding. 3. It was recommended that maternal ART and infant prophylaxis should be continued until one week after breastfeeding ends. 4. Extended once-daily infant nevirapine up to 6 months was shown to be safe and led to a 54% reduction in MTCT of HIV-1 via breastfeeding. 5. It was demonstrated that triple antiretroviral prophylaxis (based on zidovudine, lamivudine, and lopinavir/ritonavir) was more efficient than a short prophylaxis regimen of zidovudine and single-dose nevirapine (NVP) in infected mothers. 6. It was recommended that Mothers should stop Breastfeeding gradually within one month. Abrupt weaning is associated with elevations in viral load in breast milk. 7. It was reported that the use of alkyl sulfate microbicides such as 0.1% SDS may be a choice to help inactivation of HIV-1 in breast milk. 8. Heat treatments such as Holder pasteurization, Pretoria pasteurization, and “flash-heat” treatments were shown to be a good practice eradicating HIV-1 from breast milk.
Conclusion: Improvement in PMTCT during breastfeeding is achieved by using appropriate and effective strategies for both HIV-infected mothers and their breastfed infants.
Keywords: prevention, breastfeeding, HIV