ARV and transmission through breast feeding

With all of the ARV regimens, transmission of HIV through breastfeeding remains a concern. The risk of HIV transmission through breastfeeding is in the range of 10 - 20% between birth and 18 to 24 months^.14 Factors associated with increased risk in transmission through breastfeeding include mother’s viral load, low CD4 cell counts, clinically advanced HIV infection, and breast inflammatory or infectious processes. One study has suggested that exclusive breastfeeding is associated with a lower risk of HIV transmission than mixed feeding^,15 though this observation has yet to be confirmed by other research.

The investigators of both the PETRA and the CDC/ANRS study highlighted the importance of identifying interventions to prevent HIV transmission through breastfeeding. Work to address the issue of transmission through breast milk is already underway. Trials that assess the use of antiretrovirals to decrease breast milk transmission are being planned in a number of countries (Botswana, Cd’Ivoire, Uganda and others). In addition methods to inactivate HIV in breast milk are being developed.^16,17