Peripartum HIV infection in very low birth weight infants fed 'raw' mother's own milk.

Melantha Coetzee,Suzanne D Delport

doi:10.4102/sajhivmed.v20i1.912

Abstract

BackgroundHIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received formula to prevent breast milk related HIV transmission. This denied them the benefits of breast milk, thus exposing the infant to the risk of necrotising enterocolitis (NEC). From 2010, ‘raw’ mother’s own milk (rMOM) has been recommended for term infants whose mothers’ received antenatal antiretroviral therapy (ART). At the same time, the infant received antiretroviral (ARV) prophylaxis as per the National Prevention of MTCT programme.ObjectivesTo determine the cumulative incidence of peripartum HIV infection by 4–6 weeks of age in HIV-exposed VLBW infants, who received rMOM and infant ARV prophylaxis.MethodA retrospective, observational audit over 3 years at a single institution was undertaken. The study population comprised HIV-exposed VLBW infants who received both nevirapine prophylaxis and rMOM from birth until discharge. A positive HIV-PCR by 4–6 weeks of life was used to confirm maternal to infant HIV transmission.ResultsOf the 80 eligible infants admitted between 2010 and 2013, 63 (79%) were exposed to antenatal ART. Seventy-eight (97.5%) tested HIV-PCR negative at 4–6 weeks. Of the two infants who tested positive, both presented with features of an acute HIV infection. The absence of MTCT in the remaining 78 infants given ARV prophylaxis and rMOM suggests that rMOM is an unlikely source of infection in the two infected infants.ConclusionrMOM, in the presence of infant prophylaxis, was a safe feeding option for HIV-exposed VLBW infants. It should be strongly considered for these infants, as rMOM likely provides additional maternal and child benefits.

Highlights

South Africa is the global epicentre of the human immunodeficiency virus (HIV) pandemic, with an antenatal prevalence of 31%.1 Human immunodeficiency virus-infected women are at increased risk of delivering low birth weight and/or preterm infants[2] and of transmitting infection to their infants
These infants are at risk of necrotising enterocolitis (NEC) if formula feeds are administered in an effort to reduce mother-to-child transmission (MTCT).[8]
Infant feeding regimens free tins of formula were provided for HIV-exposed infants who complied with the acceptable, feasible, affordable, safe and sustainable (AFASS) feeding criteria,[21] breastfeeding was officially adopted in August 2011 (Tshwane Declaration) as the feeding regimen of choice for all infants, including those who were HIV-exposed[25] as breast milk was shown to be safe in these infants provided they received PMTCT26 (Table 2)

Summary

Introduction

South Africa is the global epicentre of the human immunodeficiency virus (HIV) pandemic, with an antenatal prevalence of 31%.1 Human immunodeficiency virus-infected women are at increased risk of delivering low birth weight and/or preterm infants[2] and of transmitting infection to their infants. HIV transmission is higher in the absence of maternal antiretroviral therapy (ART);[3,4,5,6] greater with higher maternal viral load; greater with worsening immunosuppression (low CD4 count);[3,4,6] and is increased in the presence of maternal infections such as tuberculosis and sexually transmitted disease.[7] Increased permeability of the intestinal mucosal barrier in preterm infants further increases the risk of mother-to-child transmission (MTCT).[4,6] These infants are at risk of necrotising enterocolitis (NEC) if formula feeds are administered in an effort to reduce MTCT.[8] Mother’s own milk (MOM) is crucial to the survival of preterm infants.[9] The risk and benefit to VLBW HIV-exposed infants receiving prevention of mother-to-child transmission (PMTCT) interventions and ‘raw’ MOM (rMOM) is unclear. HIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received formula to prevent breast milk related HIV transmission.

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