HIV Transmission Through Breastfeeding a Review of Available Evidence an Update from 2001 to 2007
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HIV Transmission Through Breastfeeding A Review of Available Evidence An Update from 2001 to 2007 TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................IV ACKNOWLEDGEMENTS ................................................................................................IV ACKNOWLEDGEMENTS ................................................................................................IV ACRONYMS......................................................................................................................V GLOSSARY......................................................................................................................VI EXECUTIVE SUMMARY...................................................................................................9 1. INTRODUCTION ...........................................................................................................1 2. MOTHER-TO-CHILD TRANSMISSION OF HIV...........................................................3 2.1. HIV infection in women...........................................................................................................................................3 2.2. Rates of, and risk factors for overall mother-to-child transmission of HIV .....................................................3 2.3. Prevention of mother-to-child transmission of HIV.............................................................................................4 3. HIV TRANSMISSION THROUGH BREASTFEEDING.................................................7 3.1. Pathogenesis and mechanisms of breastfeeding transmission ............................................................................7 3.2. Risk of postnatal transmission through breastfeeding.........................................................................................7 3.3. Timing of postnatal transmission through breastfeeding....................................................................................8 3.3.1. Early postnatal transmission through breastfeeding..........................................................................................8 3.3.2. Late postnatal transmission through breastfeeding............................................................................................9 3.4. Factors associated with risk of transmission of HIV through breastfeeding ..................................................11 3.4.1. Maternal factors................................................................................................................................................11 3.4.2. Infant factors.....................................................................................................................................................14 4. BENEFITS OF BREASTFEEDING.............................................................................17 4.1. Health benefits of breastfeeding in the general population...............................................................................17 4.1.1. Maternal health benefits ...................................................................................................................................17 4.1.2. Child health benefits.........................................................................................................................................17 4.2. Health benefits of breastfeeding in children born to HIV-infected mothers...................................................19 4.2.1. HIV-exposed children, regardless of HIV status.............................................................................................19 4.2.2. HIV-infected children.......................................................................................................................................19 4.3. Global breastfeeding practices..............................................................................................................................20 Literature review on HIV and Infant feeding ii 5. STRATEGIES TO REDUCE HIV TRANSMISSION THROUGH BREASTFEEDING 22 5.1. Primary prevention of HIV in women of childbearing age...............................................................................22 5.2. Framework to assess interventions to prevent postnatal transmission............................................................22 5.3. Modifying infant feeding options for HIV-infected women: replacement feeding.........................................23 5.3.1. Social acceptability of feeding practices..........................................................................................................24 5.3.2. Adverse outcomes of alternatives to breastfeeding practices..........................................................................25 5.3.3. HIV-infection....................................................................................................................................................26 5.3.4. HIV-free survival..............................................................................................................................................26 5.3.5. Discussion.........................................................................................................................................................26 5.4. Strategies for HIV-infected women who breastfeed...........................................................................................34 5.4.1. Exclusive breastfeeding....................................................................................................................................34 5.4.2. Early cessation of breastfeeding.......................................................................................................................35 5.4.3. Heat treatment or pasteurization of expressed breast milk..............................................................................37 5.4.4. Microbicide treatment of expressed breast milk..............................................................................................38 5.4.5. Antiretroviral therapy during breastfeeding.....................................................................................................38 5.5. Immunization of breastfed newborns ..................................................................................................................40 5.6. Translating research to public health recommendations on infant feeding....................................................41 6. ONGOING OR PLANNED RESEARCH ADDRESSING THE BREASTFEEDING PERIOD ...........................................................................................................................43 7. CONCLUSION.............................................................................................................45 8. REFERENCES ............................................................................................................46 Literature review on HIV and Infant feeding iii Acknowledgements This review was updated by Valériane Leroy (INSERM U593, Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen, Bordeaux, France). It is based on an original review on HIV transmission through breastfeeding prepared by Marie-Louise Newell (Institute of Child Health, London) for WHO in 2003. This review was updated in 2005 by the WHO Department of Nutrition for Health and Development as a background paper for a consultation on Nutrition and HIV. We are very grateful to Marie-Louise Newell for helping in structuring the early draft of this review and to Lynne Mofenson for providing useful information on synthesis of the technical consultation. We would like to especially thank Rajiv Bahl, Renaud Becquet, André Briend, Anirban Chatterjee, Anna Coutsoudis, François Dabis, Mary Glenn Fowler, Peggy Henderson, Lida Lhotska, Jose Martines, Ellen Piwoz, Felicity Savage, Constanza Vallenas and Isabelle de Vincenzi for reviewing the report and giving helpful comments. Finally, we would like to acknowledge the contributions of Coralie Thore, Christian Weller and Evelyne Mouillet from the ISPED library in Bordeaux for their help in researching papers. Kai Lashley performed the final copy-edit of the text. Literature review on HIV and Infant feeding iv Acronyms 3TC lamivudine AIDS acquired immunodeficiency syndrome ANRS Agence Nationale de Recherches sur le SIDA (France) ARV antiretroviral ART antiretroviral therapy AZT azidothymidine BF breastfeeding CI confidence interval D4T stavudine ddI didanosine DNA deoxyribonucleic acid EBF exclusive breastfeeding FF formula feeding HAART highly-active antiretroviral therapy HIVIGLOB HIV hyperimmune globulin HIV human immunodeficiency virus HR hazard ratio MF mixed feeding MTCT mother-to-child transmission of HIV NVP nevirapine OR odds ratio PCR polymerase chain reaction PMTCT prevention of mother-to-child transmission of HIV RF replacement feeding RNA ribonucleic acid SLPI secretory leukocyte protease inhibitor SDS sodium dodecyl sulfate UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNGASS/AIDS United Nations General Assembly Special Session on HIV/AIDS UNICEF United Nations Children’s Fund WHO World Health Organization ZDV zidovudine Literature review on HIV and Infant feeding v Glossary Breast-milk substitute refers to any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not suitable for that purpose. CD4 cells (also known as T4 or helper T cells) are lymphocytes