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2001, Number 1

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Enf Infec Microbiol 2001; 21 (1)

Breast-feeding and transmission of Human Immunodeficiency Virus

Izazola LJA

Language: Spanish
References: 41
Page: 29-37
PDF size: 110.78 Kb.


ABSTRACT

The prevention of the transmission of the Human Immuno-deficiency Virus (HIV) from mothers to infants (vertical transmission) is a priority because of ethics; in addition, because of its cost-efficiency and highly efficacious results.
In general, the level of transmission can vary according to different variables, however, it is estimated that around 35% of children born from HIV infected women may acquire HIV perinatally: 10% during pregnancy, 10% intra part, and 15% through breastfeeding.
The transmission of HIV can be drastically reduced by using Zidovudine perinatally; decrease of 50-60% in transmission. The results of treatment protocol ACTG 076 was described in 1994 by achieving a transmission rate of 8% (66% reduction); a shorter course of treatment, and easier (oral treatment only) achieved a decrease of 50% of the transmission rate: 9% when breastfeeding was excluded.
The justification of preventive interventions, in addition of an ethical component, is based on being cost-effective even in low prevalence areas. These interventions are mainly cost-effective because the provision of combined anti-retroviral treatment both to adults as well as to paediatric cases.
Despite the controversy that arises because of the rights of the women and the children to be born, it is considered that the diagnosis of HIV infection in the women must be voluntary, as well as any other therapeutics and procedures that might be the consequence of a positive result (e.g. replacement feeding of the newborn, anti-retroviral treatment to the women and to the newborns, etc.).
It is particularly important in the strategy to decrease the mother-to-child transmission of HIV the infant nutrition. It is widely accepted and undisputed that breastfeeding is the best strategy for infant health in poor developing countries. However, it is also recognised that HIV is transmitted by breastfeeding. Thus, HIV-infected women must be properly informed of their status and thoroughly counselled about the risk of transmission to the unborn child. When assuring an ade- quate, hygienic and sustainable source of nutrition, these women may freely take the decision to reduce the probability to transmit HIV after birth by replacement feeding following international standards already set for these purposes.


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