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Somé EN, Engebretsen IMS, Nagot N, Meda N, Lombard C, Vallo R, Peries M, Kankasa C, Tumwine JK, Hofmeyr GJ, Singata M, Harper K, Van De Perre P, Tylleskar T. Breastfeeding patterns and its determinants among mothers living with Human Immuno-deficiency Virus -1 in four African countries participating in the ANRS 12174 trial. Int Breastfeed J 2017; 12:22. [PMID: 28469697 PMCID: PMC5414228 DOI: 10.1186/s13006-017-0112-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/10/2017] [Indexed: 11/20/2023] Open
Abstract
Background HIV-1 transmission rates have been reduced over the last decade, an estimated 2 million new infections per year arise, including 220,000 paediatric cases. The main post-natal HIV exposure is through breastfeeding, where both its duration and modality (exclusive or not) are associated with postnatal transmission. The ANRS 12174 trial compared HIV-1 postnatal transmission of 2 prophylaxis drugs for infants during lactation (lamivudine and lopinavir-ritonavir). Our objective has been to examine the feeding practices and the determinants of exclusive/ predominant (EPBF) or any breastfeeding among the participants of this trial in Burkina Faso, South Africa, Uganda and Zambia. Methods Mothers infected with HIV-1 and their uninfected offspring were followed from day 7 after birth for 50 weeks, keeping monthly records of their feeding patterns. Feeding was classified into 3 categories: 1) exclusive breastfeeding during the first six months, only breast-milk being given to infant for 6 months, 2) predominant breastfeeding, breast-milk with liquid-based items being given, and 3) mixed feeding, other non-breast milk or solid food being given in addition to breast milk with or without liquid-based items. The categories were merged into 2 groups: EPBF applying to infants aged <6 months and mixed feeding applying to infants of any age. The feeding patterns have been given as Kaplan-Meier curves. A flexible parametric multiple regression model was used to identify the determinants of the mothers’ feeding behaviour. Results A total of 1,225 mother-infant pairs provided feeding data from Burkina Faso (N = 204), South Africa (N = 213), Uganda (N = 274) and Zambia (N = 534) between November 2009 and March 2013. The mean maternal age was 27.4 years and the mean BMI was 24.5. 57.7 and 93.9% of mothers initiated breastfeeding within the first hour and first day, respectively. Overall, the median durations of any form of breastfeeding and EPBF were 40.6, and 20.9 weeks, respectively. Babies randomized to the lopinavir/ritonavir group in South Africa tended to do less EPBF than those in the lamivudine group. Overall the group of mothers aged between 25 and 30 years, those married, employed or multiparous tended to stop early EPBF. Mothers living in Uganda or Zambia, those aged between 25 -30 years, better educated (at least secondary school level), employed or having undergone C-section stopped any breastfeeding early. Conclusions There is a need to improve breastfeeding and complementary feeding practices of children, particularly those exposed to HIV and anti-retrovirals, taking into account context and socio-demographic factors. Trial registration Clinical trial registration: NCT00640263. Electronic supplementary material The online version of this article (doi:10.1186/s13006-017-0112-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eric N Somé
- Centre for International Health, University of Bergen, Bergen, Norway.,National Health Research Institute, Centre National pour la Recherche Scientifique et Technologique, 10 BP 250 Ouagadougou, Burkina Faso
| | | | - Nicolas Nagot
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France.,Centre Hospitalier Universitaire, Montpellier, France
| | - Nicolas Meda
- Faculty of Health Sciences, Centre de Recherche International en Santé (CRIS), University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Carl Lombard
- South African Medical Research Council, Biostatistics Unit, Cape Town, South Africa
| | - Roselyne Vallo
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Marianne Peries
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France
| | - Chipepo Kankasa
- Department of Paediatrics and Child Health, University of Zambia, School of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - James K Tumwine
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, School of Medicine, Kampala, Uganda
| | - G Justus Hofmeyr
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Mandisa Singata
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Kim Harper
- Effective Care Research Unit, University of Fort Hare, Eastern Cape, South Africa
| | - Philippe Van De Perre
- INSERM UMR 1058, Pathogenesis and control of chronic infections, Montpellier, France.,Université de Montpellier, Montpellier, France.,Centre Hospitalier Universitaire, Montpellier, France
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Infant and Young Child Feeding Counseling, Decision-Making, and Practices Among HIV-Infected Women in Malawi's Option B+ Prevention of Mother-to-Child Transmission Program: A Mixed Methods Study. AIDS Behav 2016; 20:2612-2623. [PMID: 27022939 DOI: 10.1007/s10461-016-1378-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined infant and young child feeding (IYCF) counseling, decision-making, and practices among HIV-infected women with children 0-23 months participating in Malawi's Option B+ prevention of mother-to-child transmission (PMTCT) program. We conducted 160 survey interviews, 32 in-depth interviews, and 32 observations of PMTCT visits. Surveys indicated that exclusive breastfeeding was common (75 %) among children <6 months, while minimum dietary diversity (41 %) and minimum acceptable diet (40 %) for children 6-23 months occurred less often. In-depth interviews supported these findings. Most women felt comfortable with current breastfeeding recommendations, but chronic food insecurity made it difficult for them to follow complementary feeding guidelines. Women trusted IYCF advice from health workers, but mainly received it during pregnancy. During observations of postnatal PMTCT visits, health workers infrequently advised on breastfeeding (41 % of visits) or complementary feeding (29 % of visits). This represents a missed opportunity for health workers to support optimal IYCF practices within Option B+.
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Ezeamama AE, Duggan C, Manji KP, Spiegelman D, Hertzmark E, Bosch RJ, Kupka R, Okuma JO, Kisenge R, Aboud S, Fawzi WW. Clinical malaria diagnosis in pregnancy in relation to early perinatal mother-to-child transmission of HIV: a prospective cohort study. HIV Med 2013; 15:276-85. [PMID: 24215465 DOI: 10.1111/hiv.12111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy (MIP) in relation to child HIV infection among 2368 pregnant HIV-positive women and their infants, followed up from pregnancy until 6 weeks post-delivery in Tanzania. METHODS Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal health care. Child HIV status was determined via DNA polymerase chain reaction (PCR). Multivariable logistic regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for HIV mother-to-child transmission (MTCT) by the 6th week of life. RESULTS Mean gestational age at enrolment was 22.2 weeks. During follow-up, 16.6% of mothers had at least one MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven per cent of HIV-exposed infants were HIV-positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinically diagnosed with MIP (RR 1.24; 95% CI 0.94-1.64), were diagnosed with one vs. no clinical MIP episodes (RR 1.07; 95% CI 0.77-1.48) and had ever vs. never reported fever symptoms (RR 1.04; 95% CI 0.78-1.38) in pregnancy. However, the HIV MTCT risk increased by 29% (95% CI 4-58%) per MIP episode. Infants of women with at least two vs. no MIP diagnoses were 2.1 times more likely to be HIV infected by 6 weeks old (95% CI 1.31-3.45). CONCLUSIONS Clinical MIP diagnosis, but not fevers, in HIV-positive pregnant women was associated with an elevated risk of early HIV MTCT, suggesting that malaria prevention and treatment in pregnant HIV-positive women may enhance the effectiveness of HIV prevention in MTCT programmes in this setting. Future studies using a laboratory-confirmed diagnosis of malaria are needed to confirm this association.
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Affiliation(s)
- A E Ezeamama
- Department of Epidemiology & Biostatistics, University of Georgia, Athens, GA, USA
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Kiderlen TR, Conteh M, Roll S, Seeling S, Weinmann S. Cross-sectional study assessing HIV related knowledge, attitudes and behavior in Namibian public sector employees in capital and regional settings. PLoS One 2013; 8:e75593. [PMID: 24073273 PMCID: PMC3779163 DOI: 10.1371/journal.pone.0075593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022] Open
Abstract
The study objective was to assess the current status of HIV knowledge, attitudes and behavior (KAB) among employees of Namibian ministries. As most HIV campaigning takes place in the capital of Windhoek, an additional aim was to compare Windhoek to four regions (Hardap, Erongo, Oshana, and Caprivi). Between January and March 2011 a cross-sectional survey was conducted in two Namibian ministries, with participants selected randomly from the workforce. Data collection was based on questionnaires. 832 participants were included in the study (51.6% male). Nearly 90% of participants reported to have been tested for HIV before. Knowledge about HIV transmission ranged from 67% to 95% of correct answers, with few differences between the capital and regions. However, a knowledge gap regarding HIV transmission and prevention was seen. In particular, we found significantly lower knowledge regarding transmission from mother-to-child during pregnancy and higher rate of belief in a supernatural role in HIV transmission. In addition, despite many years of HIV prevention activities, a substantial proportion of employees had well-known HIV risk factors including multiple concurrent partnership rates (21%), intergenerational sex (19%), and lower testing rates for men (82% compared to women with 91%).
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Affiliation(s)
- Til R. Kiderlen
- Department of Medicine, Hematology/Oncology/Infectious Diseases/Rheumatology, Goethe University, Frankfurt, Germany
- Institute of Tropical Medicine and International Health, Charité–Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
| | - Michael Conteh
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
- Namibia Institute of Public Administration and Management, Windhoek, Namibia
| | - Stephanie Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Seeling
- Berlin School of Public Health, Carité-Universitätsmedizin, Berlin, Berlin, Germany
| | - Stefan Weinmann
- Institute for Social Medicine, Epidemiology and Health Economics, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Deutsche Gesellschaft für Internationale Zusammenarbeit, Berlin, Germany
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Tomasoni LR, Galli M, Declich S, Pietra V, Croce F, Pignatelli S, Fabiani M, Simporé J, Mabilia M, Ayella EO, Caracciolo C, Russo G, Guaraldi G, Gambirasio MN, Vullo V, Castelli F. Knowledge, attitudes and practice (KAP) regarding newborn feeding modalities in HIV-infected and HIV-uninfected pregnant women in sub-Saharan Africa: a multicentre study. Int Health 2013; 3:56-65. [PMID: 24038051 DOI: 10.1016/j.inhe.2010.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Exclusive formula feeding, exclusive breastfeeding (EBF) with early weaning or the administration of antiretroviral therapy to lactating mothers and/or to breastfed newborns may lower postnatal HIV transmission. The aim of this study was to assess mothers' knowledge, attitudes and practice (KAP) on lactation in various real-life settings in sub-Saharan Africa. A questionnaire survey investigating KAP with regard to breastfeeding in pregnant women of unknown status (Questionnaire A, 16 items) or HIV-infected women (Questionnaire B, 37 items) was administered. Associations between newborn feeding KAP and demographic, socioeconomic, cultural and obstetric variables were investigated. From January 2007 to January 2008, 2112 pregnant women answered Questionnaire A in Burkina Faso, Cameroon, Chad, Tanzania, Uganda and Zambia. Most women (53.0%) declared EBF as the preferred feeding modality. The practice of strictly defined EBF in previous pregnancies was only 11.4%, which was inversely correlated with education and parity. Questionnaire B was answered by 225 HIV-infected pregnant women in Burkina Faso, Tanzania and Uganda. Knowledge about the lactation-associated risk was associated with previous dead children. Significant variability was observed among collaborating sites. The introduction of fluids other than maternal milk within 6 months of age is common practice in sub-Saharan Africa, requiring intensive health education efforts if strictly defined EBF is to be adopted to decrease HIV postnatal transmission. Significant variation in newborn feeding determinants was observed.
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Affiliation(s)
- L R Tomasoni
- Department for Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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da Cruz Gouveia PA, da Silva GAP, de Fatima Pessoa Militão de Albuquerqu M. Factors associated with mother-to-child transmission of the human immunodeficiency virus in Pernambuco, Brazil, 2000-2009. Trop Med Int Health 2012; 18:276-85. [DOI: 10.1111/tmi.12042] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reinsma K, Bolima N, Fonteh F, Okwen P, Yota D, Montgomery S. Incorporating cultural beliefs in promoting exclusive breastfeeding. AFRICAN JOURNAL OF MIDWIFERY AND WOMEN'S HEALTH 2012; 6:65-70. [PMID: 26973717 DOI: 10.12968/ajmw.2012.6.2.65] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Since 2003, the World Health Organization has recommended exclusive breastfeeding for the first 6 months of life. In the Northwest region of Cameroon approximately 90% of women initiate breastfeeding, yet only 34% of these women exclusively breastfeed for the recommended six months. AIM To determine influences on women's exclusive breastfeeding practices. METHODS Semi-structured interviews were conducted with six women and six men followed by focus group discussions with three groups of women and three groups of men in the Kumbo West Health District, Northwest region, Cameroon. All participants were selected using theoretical sampling to assure triangulation. RESULTS Three themes emerged that influence exclusive breastfeeding practices: woman's readiness to exclusively breastfeed; cultural influences towards exclusive breastfeeding; and perceived constraints to exclusive breastfeeding. CONCLUSION These emergent themes were used to create a theoretical framework that is useful for developing a breastfeeding health education intervention in non-Western settings.
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Affiliation(s)
- Kathryn Reinsma
- School of Public Health, Loma Linda University, California, USA
| | | | - Florence Fonteh
- Department of Biomedical Sciences, University of Dschang, Cameroon
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Ødegård J, Gitterle T, Madsen P, Meuwissen THE, Yazdi MH, Gjerde B, Pulgarin C, Rye M. Quantitative genetics of Taura syndrome resistance in Pacific white shrimp (Penaeus vannamei): a cure model approach. Genet Sel Evol 2011; 43:14. [PMID: 21418636 PMCID: PMC3073882 DOI: 10.1186/1297-9686-43-14] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 03/21/2011] [Indexed: 11/28/2022] Open
Abstract
Background In aquaculture breeding, resistance against infectious diseases is commonly assessed as time until death under exposure to a pathogen. For some diseases, a fraction of the individuals may appear as "cured" (non-susceptible), and the resulting survival time may thus be a result of two confounded underlying traits, i.e., endurance (individual hazard) and susceptibility (whether at risk or not), which may be accounted for by fitting a cure survival model. We applied a cure model to survival data of Pacific white shrimp (Penaeus vannamei) challenged with the Taura syndrome virus, which is one of the major pathogens of Panaeid shrimp species. Methods In total, 15,261 individuals of 513 full-sib families from three generations were challenge-tested in 21 separate tests (tanks). All challenge-tests were run until mortality naturally ceased. Time-until-event data were analyzed with a mixed cure survival model using Gibbs sampling, treating susceptibility and endurance as separate genetic traits. Results Overall mortality at the end of test was 28%, while 38% of the population was considered susceptible to the disease. The estimated underlying heritability was high for susceptibility (0.41 ± 0.07), but low for endurance (0.07 ± 0.03). Furthermore, endurance and susceptibility were distinct genetic traits (rg = 0.22 ± 0.25). Estimated breeding values for endurance and susceptibility were only moderately correlated (0.50), while estimated breeding values from classical models for analysis of challenge-test survival (ignoring the cured fraction) were closely correlated with estimated breeding values for susceptibility, but less correlated with estimated breeding values for endurance. Conclusions For Taura syndrome resistance, endurance and susceptibility are apparently distinct genetic traits. However, genetic evaluation of susceptibility based on the cure model showed clear associations with standard genetic evaluations that ignore the cure fraction for these data. Using the current testing design, genetic variation in observed survival time and absolute survival at the end of test were most likely dominated by genetic variation in susceptibility. If the aim is to reduce susceptibility, earlier termination of the challenge-test or back-truncation of the follow-up period should be avoided, as this may shift focus of selection towards endurance rather than susceptibility.
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Position of the American Dietetic Association: Nutrition Intervention and Human Immunodeficiency Virus Infection. ACTA ACUST UNITED AC 2010; 110:1105-19. [PMID: 20645459 DOI: 10.1016/j.jada.2010.05.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
It is the position of the American Dietetic Association that efforts to optimize nutritional status through individualized medical nutrition therapy, assurance of food and nutrition security, and nutrition education are essential to the total system of health care available to people with human immunodeficiency virus (HIV) infection throughout the continuum of care. Broad-based efforts to improve health care access and treatment have stabilized HIV prevalence levels in many parts of the world and led to longer survival for people living with HIV infection. Confounding clinical and social issues, such as medication interactions, comorbidities, wasting, lipodystrophy, food insecurity, aging, and other related conditions further complicate disease management. With greater understanding of the mechanisms of HIV disease and its impact on body function, development of new treatments, and wider ranges of populations affected, the management of chronic HIV infection continues to become more complex and demanding. Achievement of food and nutrition security and management of nutrition-related complications of HIV infection remain significant challenges for clients with HIV infection and health care professionals. Registered dietitians and dietetic technicians, registered, should integrate their efforts into the overall health care strategies to optimize their clinical and social influence for people living with HIV infection.
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Goussard P, Kling S, Gie RP, Nel ED, Heyns L, Rossouw GJ, Janson JT. CMV pneumonia in HIV-infected ventilated infants. Pediatr Pulmonol 2010; 45:650-5. [PMID: 20575098 DOI: 10.1002/ppul.21228] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The contributing role of cytomegalovirus (CMV) in infants treated for Pneumocystis jiroveci pneumonia (PJP) is unknown. High dose steroids used in the treatment of PJP may further immunocompromise these infants contributing to the development of CMV pneumonia. AIM The aim of this study was to determine the role of CMV pneumonia in infants being ventilated for suspected PJP. METHODS In this prospective study HIV infected infants being treated with trimethoprim-sulfamethoxazole (TMP/SMX) and ventilated for suspected PJP were included if they had not responded to treatment. Open lung biopsy was performed if there was no improvement in ventilatory requirements. RESULTS Twenty-five HIV positive infants with a mean age of 3.3 months were included. Lung biopsy was performed in 17 (68%) and post-mortem lung tissue was obtained in 8 (32%). After evaluation of the histology, immunohistochemistry, and viral cultures from lung tissue, the most likely causes of pneumonia were: CMV and PJP dual infection 36% (n = 9), CMV pneumonia 36% (n = 9), and PJP 24% (n = 6). The pp65 test for CMV antigen was falsely negative in 24%. The mean blood CD4 count was 287/microl. There was an association between the CD4 lymphocyte status and the final diagnosis, with the CMV and PJP group (CD4 110/microl) having the lowest CD4 status (P = 0.0128). Pediatric Intensive Care Unit (PICU) mortality was 72% (n = 18) and in hospital mortality 88%. CONCLUSION Of the ventilated infants failing to respond to treatment, 72% had histologically confirmed CMV pneumonia, probably accounting for the high mortality in this cohort. The incidence of CMV disease in HIV infected infants being ventilated for severe pneumonia warrants that ganciclovir is used empirically until CMV disease is excluded. The role of lung biopsy in these circumstances needs to be researched.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa.
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Abstract
PURPOSE OF REVIEW To highlight recent research that has contributed to an improved understanding of, or resulted in, important changes in the approach to feeding HIV-exposed infants. RECENT FINDINGS The administration of antiretroviral therapy to a HIV-positive pregnant woman and its continued use during breast-feeding significantly reduce postnatal HIV transmission to her child. Similarly, extended antiretroviral prophylaxis to the breast-feeding infant dramatically decreases HIV transmission and promotes HIV-free child survival. Predominant breast-feeding may be as effective as exclusive breast-feeding in reducing HIV transmission risk. The protective role of immune modulators such as interferon-gamma and interleukin-15 in preventing breast milk transmission is being better appreciated. Although infant-feeding counseling is critical to the success of infant survival strategies, it is generally done poorly with few examples of successful consequences other than in research settings. SUMMARY Breast-feeding of HIV-exposed infants can be made considerably safer in resource-constrained settings through the provision of maternal highly active antiretroviral therapy (HAART), maternal short-course antiretrovirals, and extended infant antiretroviral prophylaxis.
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Affiliation(s)
- Haroon Saloojee
- Division of Community Paediatrics, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.
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