Preventing hiv-1 transmission in breastfed infants in low resource settings: Early hiv infection and late postnatal transmission in a routine prevention of mother-to-child transmission program in yaounde, Cameroon

Abstract

Objective: To report on overall HIV-transmission rates [early and late postnatal transmission (LPNT)] in breastfed infants born to HIV-positive women. Methods: Mother-baby pairs in a routine prevention of mother-to-child transmission program. Promotion of exclusive breastfeeding (EBF) coupled with access to antiretroviral treatment (ART) or prevention using antiretroviral (pARV). Early infant diagnosis using HIV-RNA/PCR or HIV-DNA/ PCR >6 weeks. LPNT assessed 6 weeks after weaning in infant earlier tested negative. Main measurement: early HIV infection and LPNT. Results: Weincluded 285 infants for analysis; 89.5%ofmothers were receivingART or pARV; 86%babies took daily pARV (median duration, 6 weeks). Exclusive breastfeeding (EBF) rate: 96%(median duration, 4 months). The cumulative transmission of HIV-1 was 2.8% at 8 weeks (95% confidence interval: 1.9-3.7). After weaning (abrupt 44%), 3 of 212 infants were HIV infected (1.4%). Nine-month cumulative HIVtransmission rate was 4.2%(1.5-6.9). Incidence of late postnatalHIVinfection stood at 1.5/100 child-years of breastfeeding (BF). Cumulative risk of HIV transmission (8 weeks-9 months) was 1%. Conclusion: Both promotion of EBF and access to antiretroviral therapy contribute to lower HIV transmission in breastfed infants in low resource settings ©The Author [2013]. Published by Oxford University Press. All rights reserved.