Risk of postnatal transmission can be reduced with HAART in HIV-positive mothers

Researchers conducting clinical trials in Rwanda have concluded that the risk of postnatal transmission is minimal in HIV-positive mothers undergoing highly active antiretroviral therapy (HAART) while breastfeeding. The results of the trials have been published in the current issue of AIDS, the leading journal in the field of HIV and AIDS research. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

Although formula feeding has been the recommended strategy for preventing postnatal HIV transmission in developed countries for many years, researchers have recognized that this intervention is not feasible for many women in resource-limited settings. Despite this, there had until now been no single study conducted which formally compared maternal breastfeeding with HAART with formula feeding within the same cohort in resource-limited countries.

Dr. Cécile Alexandra Peltier, together with her colleagues, conducted their study with the aim of assessing the 9-month HIV-free survival of children with two strategies to prevent HIV mother-to-child transmission. Women participating in the cohort study could choose the mode of feeding for their infant: breastfeeding with maternal HAART for six months, or formula feeding. All received HAART from 28 weeks of gestation.

Of the 227 infants who were breastfed during the trial, only one became infected with HIV, corresponding to a 9-month cumulative risk of postnatal infection of 0.5% in the breastfeeding group. Moreover, the overall mortality rate of the infants involved in the study was significantly higher in the formula-fed group (5.6%) than in the breastfed group (3.3%).

The results of the study have lead researchers to conclude that maternal HAART while breastfeeding  could be a promising alternative strategy in resource-limited settings. A key implication of this study is that women can be offered a choice in infant-feeding options, both of which could be safe and effective, given regular postnatal follow-up and counseling.