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Low rates of mother-to-child HIV transmission through breastmilk of women on antiretroviral therapy.

Most efforts for the prevention of mother-to-child transmission of HIV have concentrated on providing antiretroviral therapy around the time of delivery and during the immediate postpartum period to protect the infant. However, up to one-third of pregnancy-related transmission occurs during breastfeeding. Formula feeding may not be a safe or affordable option and the recommended exclusive breastfeeding (as opposed to mixed feeding) does not eliminate the risk of transmission. However, two recent studies suggest that continuing antiretroviral therapy during the breastfeeding period dramatically reduces the chances of transmission of the virus to infants. (1)

In the MITRA Plus trial in Tanzania, mothers received triple therapy from late pregnancy until the infant was six months old and/or breastfeeding had stopped (therapy was continued where the mother needed it for her own health). Of the 441 infants alive at six months, 5% had become infected with HIV, but less than one in five of these was infected between week 6 and 6 months. This suggests that the antiretroviral therapy proved highly protective during the breastfeeding period. (2) In the ongoing AMATA study in Rwanda, seven children were found to be HIV-infected, of whom six were infected at birth. Thus, only one infection (0.6%) has occurred during the breastfeeding period out of 174 breastfeeding women on antiretroviral therapy. Since the mother concerned had detectable viral load when she was tested, investigators believe she may have discontinued the medication. (3)

(1.) Smart T. Low rates of HIV transmission in breastfeeding women on ART. 24 July 2007.

(2.) Kilewo C, et al. Prevention of mother to child transmission of HIV-1 through breastfeeding by treating mothers prophylactically with triple antiretroviral therapy in Dares Salaam, Tanzania--the MITRA Plus study. 4th International AIDS Society Conference on HW Treatment and Pathogenesis. Sydney, 22-25 July 2007. Abstract TuAX101.

(3.) Arendt V, et al. AMATA study: effectiveness of antiretroviral therapy in breastfeeding mothers to prevent post-natal vertical transmission in Rwanda. 4th International AIDS Society Conference on HIV Treatment and Pathogenesis. Sydney, 22-25 July 2007. Abstract TuAX 102, 2007.
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Title Annotation:ROUND UP: Maternal Mortality and Morbidity; Human immunodeficiency virus
Publication:Reproductive Health Matters
Geographic Code:6TANZ
Date:Nov 1, 2007
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