Literature review for - Flourish Paediatrics

ich countries where there it is affordable and there is safe water supply (Horvath, Madi et al.
2009). In situations where breastfeeding does occur the review identified exclusive
breastfeeding, and antiretroviral prophylaxis to the breastfeeding infant as preventative
measures for the prevention of late postnatal transmission of HIV.
The use of ARV drug prophylaxis in HIV-infected nursing mothers and in HIV-exposed
infants may make breastfeeding a safer option in the developing world, where the benefit of
breastfeeding infants born to HIV-infected women may exceed the risk of transmission.
The Cochrane reviews summary of evidence on the use of antiretroviral prophylaxis
during breastfeeding
Infant nevirapine prophylaxis for six weeks or 14 weeks (among infants of mothers who were
counselled to breastfeed exclusively for six months and to consider weaning thereafter) has
shown promise with regard to prevention of MTCT of HIV and for improvement
in HIV-free survival. Such infant antiretroviral prophylaxis was well-tolerated. However, the
implications of the studies to date are that antiretroviral prophylaxis to the breastfeeding
infant must continue for the duration of breastfeeding (since the efficacy observed with
administration for six or 14 weeks dissipates after prophylaxis is discontinued). Nevirapine
resistance among those infants who fail prophylaxis and become infected while receiving
nevirapine warrants further evaluation (Horvath, Madi et al. 2009). In addition to these
finding, the Cochrane review that aimed to determine whether, and to what extent,
antiretroviral regimens decreased the risk of mother-to-child transmission of HIV also
concluded that further research is required. The authors stated that it is unclear to what extent
breastfeeding influences the efficacy of antiretroviral treatment as only a few trials in Africa
have been conducted and there results were conflicting (Volmink, Siegfried et al. 2007).
In 2010, the World Health Organization (WHO) revised their previous recommendations for
HIV-infected mothers. The WHO stated that significant research evidence regarding the use
of ARV interventions has accumulated since their last recommendations in 2006. Evidence
has been reported that ARVs to either the HIV-infected mother or HIV-exposed infant can
significantly reduce the risk of postnatal transmission of HIV through breastfeeding. In the
global context the WHO now recommend that where ARVs are available, mothers known to
be HIV-infected breastfeed until 12 months of age. The WHO encourage national authorities
in each country to decide which infant feeding practice, either breastfeeding with an
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