Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother-to-child transmission in Rwanda

Cécile Alexandra Peltier, MD, MMed (ped) 

Special Author Introduction

Opposite recommendations are given concerning breast feeding (BF) for HIV-infected women in developed and resource-limited countries. The pandemic of HIV-positive children is not controllable without drastically reducing milk transmission, even with extension of the PMTCT antiretroviral program during pregnancy. Formula feeding (FF) is not affordable for the vast majority of the population also affected by a high prevalence of HIV. As a consequence of all these passionate debates, no proper methodological studies are convincing, with the arguments of both BF and FF fanatics always repeated at all HIV congresses. No published randomized study exists to compare concomitantly FF interventional study with other post-natal interventions in limited resource settings, and no interventional study on post-natal transmission has been done in developed countries as BF is "forbidden" for HIV infected woman.

The Rwandese cohort study "AMATA" is a non-randomized clinical trial, designed to assess and compare the HIV-free survival rate of FF infants and six months BF with reduced viral load by giving systematic HAART. The results were very encouraging, as both groups have the same HIV-free survival at nine months of age, and lower mortality than in the general population. Cohort studies have very strict conditions for follow-up, often far from reality in remote places. Many comments on the AMATA study concern the low rate of post-natal transmission (only one child was infected in BF group (N=227)) showing that HAART while BF was very effective in preventing mother to child transmission. The results showing a similar mortality in FF group (N= 305), in which no child was infected after birth, were never highlighted and should encourage this intervention in comparative study.

Operational studies concerning heating manually extracted maternal milk for older children, or other solutions such as the preparation of diluted and boiled cow's milk, are also options that need to be studied, knowing that FF and HAART while BF are not accessible in remote places. Giving different options for different conditions should be a priority for operational studies to guide recommendations and give families reasonable choices to reduce mortality due to undernutrition and infections.

Read this Article

Don't miss out - further Free LWW Content is available for registered users!
Log into your account or register here to read these articles

Foreskin surface area and HIV acquisition in Rakai, Uganda
(size matters)

Kigozi et al • AIDS
ISSN: 0269-9370 • Frequency: 18/year • Impact Factor: 5.46 • Subscribe Now