Virologists have amplified the need to have maternal HIV infection identified before or during pregnancy to reduce the chances of mother-to child infection through breastfeeding
They also called on women of childbearing age to get tested and be aware of their HIV status, so as to be equipped with relevant information that would facilitate early management of the virus.
Speaking in an exclusive interview with PUNCH HealthWise, Prof. David Olaleye, a virologist at the University of Ibadan, said chances of mother-to-child transmission (perinatal) is less than one per cent if the mother is placed on drugs that would suppress the viral load.
He noted that management of perinatal HIV transmission is a complex issue, and that it is easier to manage when a woman goes through the necessary therapeutic procedures for HIV treatment – antiretroviral therapy (ART) and is given drugs effective at preventing mother-to-child transmission.
He said, “It would reduce chances of transmission. When a test is carried out, we won’t say it is not there, but it would be very low.
“There is a need to educate pregnant women on the importance of prevention and transmission of HIV to newborn.”
The member, International Society for Infectious Diseases, said the standard nutritional care for every newborn is breastfeeding as opposed to bottle feeding, noting that colostrums, which is the first form of milk produced following delivery, helps to protect against any form of infection.
“HIV is a virus that attacks the body’s immune system and is spread through certain body fluids, including breast milk.
“Mother-to-child transmission can occur during pregnancy, birth, or while breastfeeding.
“The milk is secreted from the glands and if treatment has commenced, HIV would be very low to transmit.
“For those who don’t care to enroll for care and treatment, the child could be infected in-utero, through the birth canal or through the breast milk.
“Every woman of childbearing age must know their HIV status.
“Once armed with the information, they can easily access any antenatal centre with facility for prevention of mother-to-child prevention, where there are trained personnel, with availability of free antiretroviral drugs.”
Meanwhile, in a recent clinical report from the American Academy of Paediatrics, by researchers from the Feinberg School of Medicine, Northwestern University in Chicago, USA, guidelines were presented for the evaluation and management of newborns exposed to HIV.
The recommendations, published online on October 19 in Pediatrics, a peer-reviewed journal, recommended routine HIV testing for all pregnant women unless the patient declines testing.
According to the lead author, Dr. Ellen Gould Chadwick, expedited HIV antibody testing on the mother or newborn should be performed, especially when the mother’s HIV serostatus (a term commonly used in HIV/AIDS prevention efforts) remains unknown at the time of birth.
Chadwick insisted that avoiding breastfeeding of infants continues to be a strong recommendation for women with HIV.
According to the Centers for Disease Control and Prevention, the best way to prevent perinatal transmission through breast milk is to not breastfeed.
The World Health Organisation, on its part, admitted that though, mother-to-child transmission remains the primary mode of HIV infection in infants, deciding if HIV-infected mothers should breastfeed or not, is generally based on comparing the risk of infants acquiring the virus through breastfeeding, with the increased risk of death from malnutrition, diarrhoea and pneumonia if not exclusively breastfed.
The WHO revealed that accumulating evidence had shown that being aware of HIV status, and giving antiretroviral medications to the mother or infant can significantly reduce the risk of HIV transmission through breastfeeding.
According to Medical Xpress, until recently, the WHO, advised HIV-positive mothers to avoid breastfeeding if they were able to afford, prepare and store formula milk safely.
It noted that research had emerged, particularly from South Africa, that a combination of exclusive breastfeeding and the use of antiretroviral treatment can significantly reduce the risk of transmission through breastfeeding.
“On 30 November 2009, the WHO released new recommendations on infant feeding by HIV-positive mothers, based on this new evidence.
“For the first time, WHO is recommending that HIV-positive mothers or their infants take antiretroviral drugs throughout the period of breastfeeding and until the infant is 12 months old.
“This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV,” it stated.
“WHO stated that prior research had shown that exclusive breastfeeding in the first six months of an infant’s life was associated with a three- to fourfold decreased risk of HIV transmission, when compared to infants who were breastfed and also received other milks or foods.”
Medical Xpress further noted that instrumental in guiding the new recommendations were two major African studies that announced their findings in July 2009 at the Fifth International AIDS Society conference in Cape Town.
“The WHO-led Kesho Bora study found that giving HIV-positive mothers a combination of antiretrovirals during pregnancy, delivery and breastfeeding reduced the risk of HIV transmission to infants by 42 per cent.
“The Breastfeeding Antiretroviral and Nutrition study held in Malawi also showed a risk of HIV transmission reduced to just 1.8 per cent for infants when daily given the antiretroviral drug nevirapine, while breastfeeding for 6 months,” it added.
Despite the study and guidelines, the WHO in its recommendations, advised that mothers known to be HIV-infected should be provided with lifelong antiretroviral therapy or antiretroviral prophylaxis interventions to reduce HIV transmission through breastfeeding.
The WHO stated, “National or sub-national health authorities should decide whether health services will principally counsel mothers known to be HIV-infected to either breastfeed and take antiretroviral, or, avoid all breastfeeding.
“In settings where national health authorities recommend breastfeeding for HIV-infected mothers, whose infants are HIV uninfected or of unknown HIV status, exclusive breastfeeding for the first 6 months of life is allowed, after which appropriate complementary foods are introduced with continued breast feeding.
“Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer, while being fully supported for ART adherence
“In settings where health services provide and support lifelong ART, including adherence counselling, and promote and support breastfeeding among women living with HIV, the duration of breastfeeding should not be restricted.
“Breastfeeding should then only stop once a nutritionally adequate and safe diet without breast milk can be provided.”
On safety guidance for lactating HIV positive mothers, Dr. Chadwick and her team recommended that pediatricians provide counselling to parents and caregivers of infants exposed to HIV.
They noted that the highlights should include counseling on routine care, diagnostic tests, and potential drug toxicities.
Chadwick, on her own, advised that Infants exposed to HIV undergo virological testing at 14 to 21 days of age, adding “If negative, these tests should be repeated at one to two and four to six months of age.
“Infants exposed to antiretroviral agents in utero should be monitored for drug toxicity.
“For infants exposed to HIV, immunizations and tuberculosis screening should be provided in accordance with published guidelines.
“Immediate family members of infants exposed to HIV should be offered HIV testing.
“We have come a long way in helping mothers manage perinatal HIV exposures to prevent transmission.
“We encourage open communication between doctors, patients and their families so that all appropriate therapies can be provided,” she said.
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