Prevention of postnatal HIV infection: infant feeding and antiretroviral interventions

Mother-to-child transmission of HIV causes most paediatric HIV infections. Short-course peripartum antiretroviral therapy, available in resource-constrained settings, can reduce risk for transmission around the time of delivery. Acceptable, efficient and safe interventions aimed at reducing risk for postnatal HIV transmission through breast milk remain elusive, however.

This review summarizes current knowledge on interventions to reduce risk for postnatal transmission of HIV. New information from studies conducted in Africa, where breastfeeding is the norm, suggests that modified infant feeding practices are associated with reduced transmission risk, but women need support as well as appropriate care and nutritional counselling if they are to practise these feeding modes safely. In addition, antiretroviral therapy for HIV-infected breastfeeding mothers is a promising strategy to prevent HIV transmission through breast milk in Africa. The safety and efficacy of this strategy must be assessed within large African longitudinal studies using a variety of antiretroviral regimens.

Promising interventions to reduce risk for HIV transmission through breast milk do exist, but their implementation at a population level remains insufficient. Development of a safe, effective paediatric preventive HIV vaccine would be an important advance, with a major effect on control of the HIV/AIDS pandemic.