Abstract
Introduction: To systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the World Health Organization infant feeding guidelines in the context of HIV and ART. Methods: We reviewed experimental and observational studies; exposure was maternal HIV antiretroviral therapy (and duration) and infant feeding modality; outcomes were overall and postnatal HIV transmission rates in the infant at 6, 9, 12 and 18 months. English literature from 2005 to 2015 was systematically searched in multiple electronic databases. Papers were analysed by narrative synthesis; data were pooled in random effects meta-analyses. Postnatal transmission was assessed from four to six weeks of life. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. Results and discussion: Eleven studies were identified, from 1439 citations and review of 72 abstracts. Heterogeneity in study methodology and pooled estimates was considerable. Overall pooled transmission rates at 6 months for breastfed infants with mothers on antiretroviral treatment (ART) was 3.54% (95% CI: 1.15–5.93%) and at 12 months 4.23% (95% CI: 2.97–5.49%). Postnatal transmission rates were 1.08 (95% CI: 0.32–1.85) at six and 2.93 (95% CI: 0.68–5.18) at 12 months. ART was mostly provided for PMTCT only and did not continue beyond six months postpartum. No study provided data on mixed feeding and transmission risk. Conclusions: There is evidence of substantially reduced postnatal HIV transmission risk under the cover of maternal ART. However, transmission risk increased once PMTCT ART stopped at six months, which supports the current World Health Organization recommendations of life-long ART for all.
Highlights
To systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the World Health Organization infant feeding guidelines in the context of HIV and antiretroviral treatment (ART)
These recommendations were drawn up supported by limited information on the risk of postnatal HIV transmission when women or child or both were on ART to prevent mother-to-child transmission (PMTCT)
We present the results from a systematic review and GRADE Evidence summary tables, addressing the question of HIV transmission rates at six, nine, 12 and 18 months in infants born to women who were on ART from early-mid pregnancy until at least six months postpartum, and whose infants breastfed in the first six months of life or longer
Summary
In most African countries and some parts of India, health policy continues to advise mothers living with HIV to breastfeed [9,10] In such settings, exclusive breastfeeding (EBF) for the first six months of life followed by complementary feeding and continued breastfeeding (CBF) for up to one year, under the cover of ART to either the mother or the infant [6] is recommended. Exclusive breastfeeding (EBF) for the first six months of life followed by complementary feeding and continued breastfeeding (CBF) for up to one year, under the cover of ART to either the mother or the infant [6] is recommended These recommendations were drawn up supported by limited information on the risk of postnatal HIV transmission when women or child or both were on ART to prevent mother-to-child transmission (PMTCT).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
