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Antiretroviral Meds Drastically Reduce Mother-to-Baby HIV Infection While Breastfeeding

In December of last year, I wrote about a big change in policy regarding breastfeeding and HIV in developing countries. Last week, a new study provided more good news in the transmission of HIV from mother to child during breastfeeding.

Some quick background: HIV can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding. In the developing world, mother-to-child transmission has been a major source of new infections. 

For this reason, it's been the recommendation that women who are HIV-positive not breastfeed, as long as formula feeding is "acceptable, feasible, affordable, sustainable and safe."  

Many women in developing countries don't have access to clean water, much less the resources to purchase formula, and not breastfeeding puts their infants at a high risk of death and disease. In one recent study of 14 developing countries, not breastfeeding resulted in over 325 deaths per 1,000 births compared to 35 deaths per 1,000 births among breastfed babies. 

That's why breastfeeding, even though it may mean that a child becomes infected with HIV, has been considered safer than not breastfeeding in much of the developing world. Both feeding options carry significant risks, but a child is far likelier to die earlier in life if he is not breastfed. 

For years the WHO has recommended exclusive breastfeeding in these situations until 6 months, and then abrupt weaning. Last December the WHO changed its recommendation to continuing breastfeeding for 12 months provided that the mother or baby is taking anti-retroviral medications during that period.

Now to last week's study, published in the New England Journal of Medicine.  Scientific American reports

Giving HIV-positive mothers antiretroviral therapies has been shown to reduce transmission rates during pregnancy and birth as well as during breast-feeding, but the postpartum infection rates remained variable. And in the larger population, by six months of age, about a quarter of babies whose mothers had HIV had also contracted the virus. A new study conducted in Botswana, published online June 16 in The New England Journal of Medicine, reports a breast-feeding transmission rate of just 1.1 percent with the use of prophylactic antiretrovirals.

"This is the lowest rate of mother-to-child transmission in a study from Africa, or among breast-feeding infants," Roger Shapiro, an associate professor of medicine at Harvard Medical School and lead author of the new study, said in a prepared statement.

This is great news, confirming that the new WHO recommendation will save lives. The hitch? There are two: 1) Babies whose mothers took the therapy in pregnancy had a 23% chance of delivering prematurely, and 2) the New York Times reports that funding for antiretroviral medications for mothers in the developing world is declining, a victim of the global recession. 


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