Hi Germaine
My apologies for taking a couple of days to reply
to your message. Going back through previous
reviews I've made of HIV and breastfeeding, I hope the following will help:
Transmission of HIV through exclusive
breastfeeding where the mother did not receive any antiretroviral medications:
In 1999 and 2005, research results from South
Africa and Zimbabwe, where mothers did not
receive antiretroviral medications, showed that
on testing at 6 months, the risk of HIV
transmission which could be attributed to
exclusive breastfeeding for babies from birth to
3 months (ie for babies who received no other
foods or liquids besides breastmilk) was 0% and
1.3% respectively.[1] [2] Exclusive breastfeeding
from 0-3 months was also shown to confer a
reduced risk of transmission during continued
mixed breastfeeding after 3 months; rates of
transmission from 6 15 months [3] or 6 18
months [2] for these babies were 5.3%, and 5.6%
respectively, whereas for the babies mixed fed
from birth they were 9.8% and 9.5%, to achieve in
both studies a reduced risk of transmission
during later mixed breastfeeding of at least
40%. In addition, at 18 months, the mortality
rate for the exclusively breastfed Zimbabwean
infants, whether or not HIV-infected, was less
than half that of the partially breastfed
infants. [2] A further study by the South
African group in 2007 [4] (Coovadia 2007)
succeeded in supporting HIV-infected mothers to
exclusively breastfeed for six months to show a
risk of transmission through breastfeeding of
4%. However, it should be noted that a lapse of
3 days' mixed feeding was permitted in this
definition of "exclusive breastfeeding".
Transmission of HIV through exclusive
breastfeeding when HIV+ mothers receive antiretroviral therapy
More recently, there have been at least eight
different studies done that show that where
mothers receive effective antiretroviral regimens
from early- mid pregnancy which is continued
through the period of exclusive breastfeeding, up
to 6 months, then the risk of transmission of HIV
to their babies can be reduced to less than 1%
[6-13] The most persuasive study (research
conducted by researchers from Harvard University
in Botswana, Shapiro et al [12]) shows that the
risk of transmission via EBF was 0.28%, and the
only transmissions were in women who were not
adherent to their medications. A similar
finding was found in another study from Zambia
where mothers received full ART throughout the
breastfeeding period, exclusively breastfed for
the first six months and continued partial
breastfeeding for 12 months. There were no cases
of transmission through breastfeeding for mothers
who were adherent to their medications [14]
Where mothers receive ART, but where
breastfeeding is not exclusive, then the risk of
transmission through breastfeeding is about 5% [15]
The take-home message seems to be that the risk
of HIV transmission to the breastfed baby can be
almost NIL when three pre-conditions are fulfilled:
* when HIV+ women receive the ART treatment
they need for their own health and to prevent
transmission of HIV to their babies, ie at least
from the second and third trimester of pregnancy
and throughout the whole period of breastfeeding
(preferably for life, as currently recommended)
* when HIV+ women are adherent to these medications, and
* when breastfeeding is exclusive for the first six months of life
[1] Coutsoudis A, Pillay K, Spooner E, Kuhn L,
Coovadia HM. Influence of infant-feeding
patterns on early mother-to-child transmission of
HIV-1 in Durban, South Africa: a prospective
cohort study. South African Vitamin A Study
Group. Lancet. 1999 Aug 7;354(9177):471-6.
[2] Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD,
Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, the
ZVITAMBO study group and Humphrey JH. Early
exclusive breastfeeding reduces the risk of
postnatal HIV-1 transmission and increases
HIV-free survival. AIDS 2005, 19:699708.
[3] Coutsoudis A, Pillay K, Kuhn L, Spooner E,
Tsai W-Y, Coovadia HM for the South African
Vitamin A Study Group. Method of feeding and
transmission of HIV-1 from mothers to children by
15 months of age: prospective cohort study from
Durban, South Africa. AIDS 2001;15:379-387.
[4] Coovadia HM, Rollins NC, Bland RM, Little K,
Coutsoudis A, Bennish ML, Newell
M-L. Mother-to-child transmission of HIV-1
infection during exclusive breastfeeding in the
first 6 months of life: an intervention cohort
study. Lancet 2007 March 31;369:1107-16.
[5] Iliff PJ, Piwoz EG, Tavengwa NV, Zunguza CD,
Marinda ET, Nathoo KJ, Moulton LH, Ward BJ, the
ZVITAMBO study group and Humphrey JH. Early
exclusive breastfeeding reduces the risk of
postnatal HIV-1 transmission and increases
HIV-free survival. AIDS 2005, 19:699708
[6] Palombi, L., M.C. Marazzi, A. Voetberg, and
N.A. Magid. Treatment acceleration program and
the experience of the DREAM program in prevention
of mother-to-child transmission of HIV. AIDS 2007;21(Suppl 4): S65.71
[7] Kilewo, C., K. Karlsson, A. Massawe, et al.
Prevention of mother-to-child transmission of
HIV-1 through breast-feeding by treating infants
prophylactically with lamivudine in Dar es
Salaam,Tanzania: the Mitra Study. Journal of
Acquired Immune Deficiency Syndrome 2008;48(3): 315.23.
[8] Kilewo, C., K. Karlsson, M. Ngarina, et al.
Prevention of mother to child transmission of
HIV-1 through breastfeeding by treating mothers
with triple antiretroviral therapy in Dar es
Salaam, Tanzania: the Mitra Plus study. Journal
of Acquired Immune Deficiency Syndrome 2009;52(3): 406.16.
[9]Marazzi, M.C., K. Nielsen-Saines, P.E.
Buonomi, et al. Increased infant human
immunodeficiency virustype one free survival at
one year of age in sub-Saharan Africa with
maternal use of Highly Active Antiretroviral
Therapy during breast-feeding. Pediatric
Infectious Disease Journal 2009;28: 483.487.
[10] Peltier, C.A., G.F. Ndayisaba, P. Lepage,
et al. Breastfeeding with maternal antiretroviral
therapy or formula feeding to prevent HIV
postnatal mother-to child transmission in Rwanda. AIDS 2009;23:2415.23.
[11] Thomas TK, Masaba R, Borkowf CB, Ndivo R,
Zeh C, Misore A, et al. Triple-Antiretroviral
Prophylaxis to Prevent Mother-To-Child HIV
Transmission through Breastfeeding-The Kisumu
Breastfeeding Study, Kenya: A Clinical Trial.
Plos Medicine 2011. Mar;8(3) e1001015.
[12] Shapiro RL, Hughes MD, Ogwu A, et al.
Antiretroviral regimens in pregnancy and
breast-feeding in Botswana. N Engl J Med 2010;362: 2282.94.
[13] Homsy J et al. Breastfeeding,
mother-to-child HIV transmission, and mortality among infants born
to HIV-Infected women on highly active
antiretroviral therapy in rural Uganda. Journal
of Acquired Immune Deficiency Syndromes, 2010, 53(1):28.35.
[14] Silverman M, Preliminary Results of HIV
Transmission Rates Using a Lopinavir/ritonavir
(LPV/r, Aluvia) based regimen and the New WHO
Breast Feeding Guidelines for PMTCT of HIV, 51st
Interscience Conference on Antimicrobial Agents
and Chemotherapy (ICAAC): Abstract H1-1153. Presented September 19, 2011
[15] Kesho Bora Study Group, Triple
antiretroviral compared with zidovudine and
single-dose nevirapine prophylaxis during
pregnancy and breastfeeding for prevention of
mother-to-child transmission of HIV-1 (Kesho Bora
study): a randomised controlled trial, The Lancet
2011; DOI:10.1016/S1473-3099(10)70288-7
____________________________________
Finally, at the beginning of this month
WABA published a Comprehensive Resource on
International Policy on HIV and Breastfeeding,
where you can find all the above facts and
figures and a whole lot more background on the
research and how HIV and breastfeeding has
evolved over the years. It can be downloaded
at
<http://www.waba.org.my/whatwedo/hcp/ihiv.htm#kit>http://www.waba.org.my/whatwedo/hcp/ihiv.htm#kit
. Please let me know if I can help you further.
Pamela Morrison IBCLC
Rustington, England
------------------------------------------
Date: Fri, 21 Dec 2012 07:41:13 -0500
From: germaine lambergs <[log in to unmask]>
Subject: sero conversion for infants.
Dear Lactnet, Can anyone direct me to the research that discusses the
sero conversion rate for infants that have HIV + mothers who
exclusively breastfeed their infants. thank you so much Germaine
lambergs.
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