WHO could soon introduce new recommandations on HIV and breastfeeding

[5 August 2009 - 11h54]

The recommendations of the World Health Organisation (WHO) aimed at preventing mother-to-child transmission of HIV could be changed at the end of the year. Instead of the short protocols currently recommended, a “long” period of tritherapy during the last trimester of pregnancy, and continued for 6 months after the birth if the mother is breastfeeding, will reduce by 42% the risk of the virus being transmitted.

It must still be combined with the infant receiving the antiretroviral drug nevirapine. This study led by the WHO, with the ANRS (the French National Agency for AIDS research), the Center for Diseases Control and Prevention (CdC) and the American National Institutes of Health, was made public at the recent IAS conference in South Africa.

Mother-to-child transmission of HIV is a major risk. Though the standard treatments used in the critical periods of labour and birth have considerably reduced it. However, the idea of breastfeeding is out of the question. As an exception to its usual rules, the WHO recommends the use of artificial baby milk (formula) providing that it is “acceptable, practicable, economically viable, possible over the long term and safe …”. It must also be “exclusive” to avoid any pollution due to poorly controlled formula feeding.

No compassionate access to formula feeding

In sub-Saharan Africa, it is impossible for all these conditions to be met. “In Burkina Faso 40% of rural homes live on less than one dollar a day”, explains Dr Nicolas Meda (of Bobo Dioulasso), co-author of the Kesho Bora study. “Maternal and infant mortality are among the highest in the world and sanitation, along with access to drinking water, are an ongoing challenge.” As in many African countries, the use of formula is therefore both dangerous and prohibitive.

Kesho Bora – which means for a better future [ed. note] – is a study that took place simultaneously in Burkina Faso, Kenya and South Africa, involving 824 mothers-to-be, all of whom were infected with HIV. The rate of mother-to-child transmission was brought down to 5.5% by the 12th month instead of the 9.5% which was the current standard. “This strategy has proved its effectiveness”, comments Dr Kevin Naidu (University of Kwazulu, Durban), who was responsible for the South African study group. “Now we must ensure that both mothers and children have access to these treatments.”.

In Africa, there is no compassionate distribution of breast milk substitutes … There is however compassionate distribution of free medication… “We must transfer our results to national programmes”, explains Nicolas Meda. Thanks to funding from the Global Fund “everything is free for the mother and child. Men have to pay a contribution of 1,500 CFA (3 euros) per month for treatment and 3,000 CFA (6 euros) for biological monitoring. Is this feasible? Yes, it is. “In Malawi and Botswana, other teams have shown that it is possible to go further still by starting to treat not just for three months but for six months before birth…”

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; interview with Dr Nicolas Meda, 22 July 2009; Professor François Dabis, 22 July 2009.

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