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Keane A, Lyons F, Aebi-Popp K, Feiterna-Sperling C, Lyall H, Martínez Hoffart A, Scherpbier H, Thorne C, Albayrak Ucak H, Haberl A. Guidelines and practice of breastfeeding in women living with HIV-Results from the European INSURE survey. HIV Med 2024; 25:391-397. [PMID: 38031396 DOI: 10.1111/hiv.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Antiretroviral therapy (ART) is integral to HIV prevention, including averting vertical transmission. The World Health Organization (WHO) recommends ART and breastfeeding for all women living with HIV for at least 12 months post-partum [1, 2]. Much of the data on HIV transmission through breastfeeding comes from low-resource settings, with a paucity of data on breastfeeding-related HIV transmission in women living with HIV in other settings. Women Against Viruses in Europe (WAVE), part of the European AIDS Clinical Society (EACS), aims to improve the standard of care for women living with HIV and sought to gain an understanding of breastfeeding guidelines and practice in women living with HIV across Europe. METHODS A steering group convened by WAVE developed a survey to collate information on breastfeeding trends, practice, and guideline recommendations for women living with HIV in Europe and to establish interest in becoming involved in a collaborative breastfeeding network. The survey was disseminated to 31 countries in March 2022. RESULTS In total, 25 eligible responses were received: 23/25 (92%) countries have HIV and pregnancy guidelines; 23/23 (100%) guidelines refer specifically to breastfeeding; 12/23 (52%) recommend against breastfeeding; 11/23 (48%) offer an option if certain criteria are met; 12/25 (48%) reported that the number of women living with HIV who breastfeed is increasing; 24/25 (96%) respondents were interested in joining a network on breastfeeding in women living with HIV. CONCLUSIONS Recommendations vary, and nearly half of the guidelines recommend against breastfeeding. Many countries report an increase in breastfeeding. WAVE will establish a collaborative network to bridge data gaps, conduct research, and improve support for women living with HIV who choose to breastfeed.
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Affiliation(s)
- A Keane
- Department of Infectious Disease and Genitourinary Medicine, St James Hospital Dublin, Dublin, Ireland
| | - F Lyons
- Department of Infectious Disease and Genitourinary Medicine, St James Hospital Dublin, Dublin, Ireland
| | - K Aebi-Popp
- Department of Infectious Diseases, University Hospital Bern, University of Bern, Switzerland, Switzerland
| | - C Feiterna-Sperling
- Charité Universitätsmedizin Berlin, Klinik für Pädiatrie m. S. Pneumologie, Immunologie und Intensivmedizin, Berlin, Germany
| | - H Lyall
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| | - A Martínez Hoffart
- Posithiva Gruppen, Knowledge Network for Women Living with HIV, Stockholm, Sweden
| | - H Scherpbier
- Department of Paediatrics, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - C Thorne
- University College London, Great Ormond Street Institute of Child Health, London, UK
| | - H Albayrak Ucak
- CPL Life Science, Vaccine Research and Development, Reading, UK
| | - A Haberl
- Department of Internal Medicine, Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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2
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Tarancón-Diez L, Rull A, Herrero P, Vazquez-Alejo E, Peraire J, Guillén S, Navarro-Gomez ML, Viladés C, Muñoz-Fernandez MÁ, Vidal F. Early antiretroviral therapy initiation effect on metabolic profile in vertically HIV-1-infected children. J Antimicrob Chemother 2021; 76:2993-3001. [PMID: 34463735 DOI: 10.1093/jac/dkab277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/02/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early combined antiretroviral treatment (cART) in perinatally acquired HIV-1 children has been associated with a rapid viral suppression, small HIV-1 reservoir size and reduced mortality and morbidity. Immunometabolism has emerged as an important field in HIV-1 infection offering both relevant knowledge regarding immunopathogenesis and potential targets for therapies against HIV-1. OBJECTIVES To characterize the proteomic, lipidomic and metabolomic profile of HIV-1-infected children depending on their age at cART initiation. PATIENTS AND METHODS Plasma samples from perinatally HIV-1-infected children under suppressive cART who initiated an early cART (first 12 weeks after birth, EARLY, n = 10) and late cART (12-50 weeks after birth, LATE, n = 10) were analysed. Comparative plasma proteomics, lipidomics and metabolomics analyses were performed by nanoLC-Orbitrap, UHPLC-qTOF and GC-qTOF, respectively. RESULTS Seven of the 188 proteins identified exhibited differences comparing EARLY and LATE groups of HIV-1-infected children. Despite no differences in the lipidomic (n = 115) and metabolomic (n = 81) profiles, strong correlations were found between proteins and lipid levels as well as metabolites, including glucidic components and amino acids, with clinical parameters. The ratio among different proteins showed high discriminatory power of EARLY and LATE groups. CONCLUSIONS Protein signature show a different proinflammatory state associated with a late cART introduction. Its associations with lipid levels and the relationships found between metabolites and clinical parameters may potentially trigger premature non-AIDS events in this HIV-1 population, including atherosclerotic diseases and metabolic disorders. Antiretroviral treatment should be started as soon as possible in perinatally acquired HIV-1-infected children to prevent them from future long-life complications.
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Affiliation(s)
- Laura Tarancón-Diez
- Molecular Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain
| | - Anna Rull
- Universitat Rovira i Virgili, Tarragona, Spain.,Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain.,Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Pol Herrero
- Eurecat, Centre Tecnològic de Catalunya, Unitat de Ciències Òmiques (Unitat Mixta de Eurecat-Universitat Rovira i Virgili), Infraestructura Científico-Tècnica Singular (ICTS), Reus, Spain
| | - Elena Vazquez-Alejo
- Molecular Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain
| | - Joaquim Peraire
- Universitat Rovira i Virgili, Tarragona, Spain.,Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain.,Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Sara Guillén
- Department of Pediatrics, Hospital Universitario de Getafe, Madrid, Spain
| | - Maria Luisa Navarro-Gomez
- Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain
| | - Consuelo Viladés
- Universitat Rovira i Virgili, Tarragona, Spain.,Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain.,Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Mª Ángeles Muñoz-Fernandez
- Molecular Immunology Laboratory, Hospital General Universitario Gregorio Marañón, Health Research Institute Gregorio Marañón (IiSGM), Madrid, Spain.,Spanish HIV-HGM BioBank, Madrid, Spain
| | - Francesc Vidal
- Universitat Rovira i Virgili, Tarragona, Spain.,Institut Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain.,Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
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3
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Reduced Time to Suppression Among Neonates With HIV Initiating Antiretroviral Therapy Within 7 Days After Birth. J Acquir Immune Defic Syndr 2020; 82:483-490. [PMID: 31714427 DOI: 10.1097/qai.0000000000002188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There are limited data on infants with HIV starting antiretroviral therapy (ART) in the neonatal period. We investigated the association between the timing of ART initiation and time-to-suppression among infants who tested HIV-positive and initiated ART within the first 28 days of life. The effect was estimated using cumulative probability flexible parametric spline models and a multivariable generalized additive mixed model was performed to test nonlinear associations. Forty-four neonates were included. Nineteen (43.2%) initiated ART within 7 days of life and 25 (56.8%) from 8 to 28 days. Infants treated within 7 days were 4-fold more likely to suppress earlier than those treated after 7 days [Hazard ratio (HR) 4.01 (1.7-9.5)]. For each week the ART initiation was delayed, the probability of suppression decreased by 35% (HR 0.65 [0.46-0.92]). Age at ART start was linearly associated with time-to-suppression. However, a linear association with normally distributed residuals was not found between baseline viral load and time-to-suppression, with no association found when baseline viral loads were ≤5 log(10) copies/mL, but with exponential increase in time-to-suppression with > log5 copies/mL at baseline. Starting ART within 7 days of life led to 4-fold faster time to viral suppression, in comparison to initiation from 8 to 28 days.
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Marcus U, Beck N. Infektionen mit dem humanen Immundefizienzvirus bei Kindern in Deutschland, 1999–2016. Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-020-00865-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Hintergrund
Mutter-Kind-Übertragungen von humanem Immundefizienz Virus (HIV) sind durch antiretrovirale Therapie der Schwangeren und weitere medizinische Maßnahmen (Sectio-Entbindung, Postexpositionsprophylaxe beim Neugeborenen, Stillverzicht) verhinderbar. Weiterhin erfolgende Übertragungen sind überwiegend Folge mangelhafter Umsetzung der bekannten wirksamen Maßnahmen. Stand und Probleme bei der Erreichung einer Eliminierung von Mutter-Kind-Übertragungen von HIV in Deutschland werden beschrieben.
Methoden
Hauptquelle der Daten sind pseudonymisierte Meldedaten des HIV-Melderegisters am Robert Koch-Institut (RKI). Mittels einer intensivierten Surveillance für HIV-Meldungen zu Kindern werden Angaben zum Geburtsland, zum mütterlichen Herkunftsland und zur Kenntnis und zum Management der mütterlichen HIV-Infektion in der Schwangerschaft bei seit 1999 geborenen, mit HIV infizierten Kindern erhoben.
Ergebnisse
Bis Ende 2018 wurden bei zwischen dem 01.01.1999 und dem 31.12.2016 geborenen Kindern im Alter unter 15 Jahren in Deutschland 331 HIV-Diagnosen gemeldet. Bei 313 war eine Mutter-Kind-Übertragung der wahrscheinlichste Übertragungsweg. Von diesen 313 Kindern wurden 162 (52 %) in Deutschland geboren, aber nur 26 % der Mütter waren deutscher Herkunft. Die HIV-Übertragungshäufigkeit bei in Deutschland geborenen Kindern sank von 1,8/100.000 Lebendgeburten im Zeitraum 1999–2007 auf 0,8/100.000 im Zeitraum 2008–2016. Bei 59 % der in Deutschland geborenen Kinder war der HIV-Status der Mutter den betreuenden Ärzt*innen zum Zeitpunkt der Geburt nicht bekannt.
Schlussfolgerung
Ein fehlendes HIV-Testangebot für die Schwangere war Hauptursache für Übertragungen bei bis 2007 geborenen Kindern; bei später geborenen Kindern waren die Gründe vielfältiger und hingen oft mit mütterlicher Migration und Zugangsbarrieren in das Versorgungssystem zusammen.
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Jiménez de Ory S, Ramos JT, Fortuny C, González-Tomé MI, Mellado MJ, Moreno D, Gavilán C, Menasalvas AI, Piqueras AI, Frick MA, Muñoz-Fernández MA, Navarro ML. Sociodemographic changes and trends in the rates of new perinatal HIV diagnoses and transmission in Spain from 1997 to 2015. PLoS One 2019; 14:e0223536. [PMID: 31647824 PMCID: PMC6812742 DOI: 10.1371/journal.pone.0223536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/22/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015. METHODS A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997-2000; P2: 2001-2005; P3: 2006-2010; P4: 2011-2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated. RESULTS A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively. CONCLUSIONS A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact.
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Affiliation(s)
- Santiago Jiménez de Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - José Tomas Ramos
- Servicio de Pediatría, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Spain
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Maria José Mellado
- Pediatrics, Immunodeficiencies and Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - David Moreno
- Department of Pediatrics, Regional Maternal-Child University Hospital, Malaga, Spain
- IBIMA Multidisciplinary Group for Pediatric Research, Malaga, Spain, Malaga University, Malaga, Spain
| | - César Gavilán
- Department of Paediatrics, University Clinical Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain
- Department of Paediatrics, Miguel Hernández University of Elche, Campus of Sant Joan d'Alacant, Alicante, Spain
| | | | - Ana Isabel Piqueras
- Department of Pediatric Surgery, and Department of Pediatrics, Hospital La Fe, Valencia, Spain
| | - M. Antoinette Frick
- Tropical Medicine and International Health Unit. Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department of Pediatrics, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Angeles Muñoz-Fernández
- Section Immunology, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain, Spanish HIV HGM BioBank, Madrid, Spain
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón and Instituto de Investigación Sanitaria Gregorio Marañón, Medical School, Universidad Complutense de Madrid, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
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6
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Di Biagio A, Taramasso L, Gustinetti G, Burastero G, Giacomet V, La Rovere D, Genovese O, Giaquinto C, Rampon O, Carloni I, Hyppolite TK, Palandri L, Bernardi S, Bruzzese E, Badolato R, Gabiano C, Chiappini E, De Martino M, Galli L. Missed opportunities to prevent mother-to-child transmission of HIV in Italy. HIV Med 2019; 20:330-336. [PMID: 30924576 DOI: 10.1111/hiv.12728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Vertical transmission of HIV can be effectively controlled through antenatal screening, antiretroviral treatment and the services provided during and after childbirth for mother and newborn. In Italy, the National Health Service guarantees universal access to prenatal care for all women, including women with HIV infection. Despite this, children are diagnosed with HIV infection every year. The aim of the study was to identify missed opportunities for prevention of mother-to-child transmission of HIV. METHODS The Italian Register for HIV Infection in Children, which was started in 1985 and involves 106 hospitals throughout the country, collects data on all new cases of HIV infection in children. For this analysis, we reviewed the database for the period 2005 to 2015. RESULTS We found 79 HIV-1-infected children newly diagnosed after birth in Italy. Thirty-two of the mothers were Italian. During the pregnancy, only 15 of 19 women with a known HIV diagnosis were treated with antiretroviral treatment, while, of 34 women who had received an HIV diagnosis before labour began, only 23 delivered by caesarean section and 17 received intrapartum prophylaxis. In 25 mothers, HIV infection was diagnosed during pregnancy or in the peripartum period. Thirty-one newborns received antiretroviral prophylaxis and 39 received infant formula. CONCLUSIONS We found an unacceptable number of missed opportunities to prevent mother-to-child transmission (MCTC). Eliminating HIV MTCT is a universal World Health Organization goal. Elucidating organization failures in Italy over the past decade should help to improve early diagnosis and to reach the zero transmission target in newborns.
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Affiliation(s)
- A Di Biagio
- Infectious Diseases Unit, Department of Internal Medicine, Policlinico San Martino Hospital, Genoa, Italy
| | - L Taramasso
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy.,Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G Gustinetti
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - G Burastero
- Infectious Diseases Unit, Department of Health Sciences (DISSAL), University of Genoa, Policlinico San Martino Hospital, Genoa, Italy
| | - V Giacomet
- Department of Pediatrics, University of Milan, L. Sacco Hospital, Milan, Italy
| | - D La Rovere
- Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | - O Genovese
- Pediatric Intensive Care Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy
| | - C Giaquinto
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - O Rampon
- Department of Child's and Woman's Health, University of Padova, Padova, Italy
| | - I Carloni
- Pediatric Unit, Department of Child and Mother Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - T K Hyppolite
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - L Palandri
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - S Bernardi
- Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, Rome, Italy
| | - E Bruzzese
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - R Badolato
- Department of Clinical and Experimental Sciences, Institute of Molecular Medicine 'Angelo Nocivelli', University of Brescia, Brescia, Italy
| | - C Gabiano
- SC Pediatric Unit, Regina Margherita Hospital, Turin, Italy
| | - E Chiappini
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - M De Martino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - L Galli
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
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Waitt C, Low N, Van de Perre P, Lyons F, Loutfy M, Aebi-Popp K. Does U=U for breastfeeding mothers and infants? Breastfeeding by mothers on effective treatment for HIV infection in high-income settings. Lancet HIV 2018; 5:e531-e536. [PMID: 29960731 DOI: 10.1016/s2352-3018(18)30098-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 12/01/2022]
Abstract
Can the campaign Undetectable=Untransmittable (U=U), established for the sexual transmission of HIV, be applied to the transmission of HIV through breastfeeding? European AIDS Clinical Society and, to some extent, American guidelines now state that mothers with HIV who wish to breastfeed should be supported, with increased clinical and virological monitoring. This Viewpoint summarises existing evidence on transmission of HIV through breastfeeding, differences in HIV dynamics and viral load between breastmilk and plasma, and the effects of antiretroviral therapy on infants. At present, insufficient evidence exists to make clear recommendations for the required frequency of clinical and virological monitoring for mother and infant in a breastfeeding relationship or for the action to be taken in the event of viral rebound. We propose a roadmap for collaborative research to provide the missing evidence required to enable mothers who wish to breastfeed to make a fully informed choice.
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Affiliation(s)
- Catriona Waitt
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Royal Liverpool University Hospital, Liverpool, UK.
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philippe Van de Perre
- Pathogenesis and Control of Chronic Infections, INSERM, University of Montpellier, Etablissement Français du Sang, CHU Montpellier, Montpellier, France
| | - Fiona Lyons
- Department of Genitourinary Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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