Literature review for - Flourish Paediatrics

Specific Conditions
Human Immunodeficiency Virus (HIV) in Breastfeeding Women
Notes on HIV and breastfeeding
Following the first report of transmission of HIV-1 through breastfeeding, the Centers for
Disease Control and Prevention (CDC) recommended that HIV-1-infected women in the
United States abstain from breastfeeding as replacement feeding is safe, affordable, and
culturally acceptable. Avoidance of breastfeeding has continued to be recommended in areas
where infant formula is accessible, affordable, safe, and sustainable (Read 2003).
A systematic literature review conducted by (Bulteel and Henderson 2007) involved a
detailed search of articles published between 1966-2007 on breastfeeding and HIV. Of the
820 papers that were retrieved 22 papers met the inclusion criteria, 5 of which were metaanalyses.
In determining the rate of breastfeeding transmission, the authors reviewed a metaanalysis
by Dunn and colleagues that estimated the frequency of breastmilk transmission
during acute maternal infection to be 29% (95% CI, 16–42) and the additional risk of HIV-1
infection in infants who breastfed for at least 2 years to be 14% (95% CI, 7.0–22.0). The
results from this meta-analysis were in line with results from several RCTs and cohort studies
that found an increased risk of 15%-18% through breastfeeding when compared to formula
feeding. The European Collaborative Study found the odds ratio (OR) of transmission to be
2.25 (95% CI, 0.97– 5.23) in breastfed versus never-breastfed children. All the studies
included in the review found breastfeeding posed a substantial risk for additional HIV
transmission. It is important to note that the transmission rates observed in these studies were
derived from populations that were not receiving the recent advancements in antiretroviral
therapy (ARV). The WHO 2010 guidelines now state that previously observed transmission
rates of HIV would likely be diminished in the presence of ARV interventions.
A recent Cochrane review aimed to collate and assess the evidence regarding interventions to
decrease late postnatal MTCT of HIV. Six randomized clinical trials and one intervention
cohort study assessing the efficacy of interventions to prevent MTCT of HIV through
breastmilk were included in the analysis. The authors concluded that complete avoidance of
breastfeeding is efficacious in preventing MTCT of HIV and is recommended in resource
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