Review of current research on breastmilk and mothe-to-infant transmission of HIV

Abstract

This review summarises whatis known about breastfeeding and HIV and discusses interventions such as micronutrient supplements and antiretroviral treatment in the perinatal and possibly the breastfeeding period, to try to decrease the risk of HIV transmission through breastmilk. It shows that breastfeeding seems to double the risk of HIV infection in infants, with a constant and cumulative risk of infection throughout the breastfeedingperiod. Formula feeding is an option but increases the risk of infant morality and morbidity from other causes. Breastfeeding could be stopped after 4–6 months where early weaning foods are available and fewer infants would become infected, but women maybe stigmatised and milk remains an important part of the infant diet for 2–3 years. Not enough is known about the effectiveness of antibody responses to HIV in breastmilk; however, women whose milk does not contain detectable antibodies maybe more likely to transmit the virus. The effect ofmaternal HIV disease on the risk of transmission has not yet been confirmed, noris it clearhow the infection crosses the infant gut mucosa, although several routes are feasible. A better scientific understanding of the infectivity ofbreastmilk and the susceptibility of the infant would help to clarify the relative risk of infection, and would seem to be a priority. In the long term, the best way to prevent infant infection with HIV is to prevent infection of women.