HIV/AIDS – breastfeeding under ARVs means less of a risk

[23 March 2011 - 15h32]

Everyone knows that breastfeeding is beneficial for infants in many ways. Even if their mothers are HIV positive … providing that they are following a particular tritherapy. This approach has been the subject of a new scientific evaluation as part of the Kesho Bora study (the name means “a better future” in Swahili).

The risk of mother-to-child transmission is considerably reduced, with even greater effectiveness among women with a high viral load. Since 2009, the WHO has recommended the administration of “antiretrovirals at an earlier stage of pregnancy: from the 14th week and up to the end of the breastfeeding period”.

The Kesho Bora study, carried out in South Africa, Burkina Faso and Kenya on 824 patients compared the effectiveness of two therapeutic approaches. The first relied on the administration of a combination of zidovudine, lamivudine and lopinavir/ritonavir.

The other protocol followed the previous WHO recommendations, ie the administration of one dose of zidovudine twice a day during pregnancy, then a single dose of nevirapine during birth.

In the first group, the researchers observed a 43% drop in the risk of transmission of the virus by the mother to the child. In the twelfth month after the birth, 5.4% of these children were found to be infected, compared with 9.5% in the other group.

As with any treatment, there are secondary effects. But the study showed that the benefit-risk balance was largely acceptable in this case. This is good news, particularly for developing countries where breastfeeding is a real plus for infants as the lack of drinking water often makes bottle feeding problematic.

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