Prevention of postnatal HIV infection: infant feeding and antiretroviral interventions

Overview & Synopsis

Purpose of the review. Mother-to-child transmission of HIV is responsible for most paediatric HIV infections. Short-course peri-partum antiretroviral therapy, available in resource-constrained settings, can reduce the risk of transmission around the time of delivery, but acceptable, efficient and safe interventions aimed at preventing the risk of postnatal HIV transmission through breastmilk remain elusive. Recent findings. This review summarises the current state of knowledge on interventions to reduce the risk of postnatal transmission. New information from studies conducted in Africa, where breastfeeding is the norm, suggest that modified infant feeding practices are associated with reduced transmission risk, but women need support as well as appropriate care and nutritional counselling to safely practise these feeding modes. In addition, antiretroviral therapy for HIV-infected breastfeeding mothers is a promising strategy to prevent HIV transmission through breastmilk in Africa. The safety and efficacy of this strategy now needs to be assessed within large African longitudinal studies using a variety of antiretroviral regimens. Summary. Promising interventions do exist to prevent the risk of HIV transmission through breastmilk, but their implementation at a population level remains insufficient. The development of a safe and effective paediatric preventive HIV vaccine would be an extremely important advance and have a major effect on control of the HIV/AIDS pandemic.