Effect of zidovudine on perinatal HIV-1 transmission and maternal viral load

Abstract

Since the publication last July of the UNAIDS, UNICEF, and WHO policy statement (http://www.unaids.org/unaids/document/mother%2Dto%2Dchild/infant.html, accessed on April 12, 1999) on HIV and infant feeding, the International Child Health Group of the Royal College of Paediatrics and Child Health has been unhappy about this endorsement of artificial feeding. The policy statement shows signs of strain in its construction of consensus, but finally decrees it to be important “that women be empowered to make fully informed decïsions about infant feeding”, and then that with “nutritionally adequate breast-milk substitutes that are safely prepared and fed to them, they [infants of mothers living with HIV] are at less risk of illness and death if they are not breast-fed”. As a global policy, this consensus has more potential for daily harm than good, because despite the post-industrialisation force for empowerment of women and freedom of choice, it is in countries where deprivation is greatest and therefore bottlefeeding most dangerous that a women is more likely to make a disastrous choice on the basis of false information. Surely it would be better, with the prevailing and foreseeable poverty in most of the world, to promote exclusive breastfeeding for 4–6 months. We should also be attempting to reduce mother-to-child transmission by increasing the use of short-course zidovudine in any setting in which this is realistic, while working on the many factors that contribute to HIV infection and that prevent social and economic development. With further reports of the effectiveness of advances on the medical prevention of vertical transmission to breastfed babies in regions of poverty,1Shaffer N Chuachoowong R Mock PA et al.Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial.Lancet. 1999; 353: 773-780Summary Full Text Full Text PDF PubMed Scopus (670) Google Scholar, 2Wiktor SZ Ekpini E Karon JM et al.Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Cóte d'lvoire: a randomised trial.Lancer. 1999; 353: 781-785Summary Full Text Full Text PDF PubMed Scopus (481) Google Scholar, 3Dabis F Msellati N Meda N et al.6-month efficacy, tolerance and acceptability of a short regimen of oral zidovudine to reduce vertical transmission of HIV in breastfed children in Cote d'lvoire and Burkina Faso: a double-blind placebo-controlled multicentre trial.Lancet. 1999; 353: 786-792Summary Full Text Full Text PDF PubMed Scopus (432) Google Scholar UNAIDS, UNICEF, and WHO should urgently revise their policy statement (which does not mention perinatal antiviral therapy) and declare their uncompromising affirmation of breastfeeding for all, in the interests of the women and children in most of the world.