From sexual to mother-to-baby transmission

In 2010, the British HIV Association (BHIVA) and the Children’s HIV Association (CHIVA) issued a proposed amendment to their existing guidelines on breastfeeding for mothers with HIV, which extends the applicability of taking viral load reduction into account as an influence on transmission risk from sexual transmission to mother-to-baby transmission. BHIVA/CHIVA underlined that formula feeding combined with antiretroviral treatment has been highly successful in bringing down the mother-to-baby transmission rate in the UK to 1-2% and to 0.1% in mothers on HAART. However, it also wished to acknowledge that social and cultural pressures meant that sometimes women felt they had no option but to breastfeed. They therefore proposed the following:

• “BHIVA/CHIVA acknowledges that, in the UK, the risk of mother-to-child transmission from a woman who is on HAART and has a consistently undetectable HIV viral load is likely to be low but has not yet been quantified.
• Therefore, although formula feeding is still the best and safest option in the UK to prevent mother-to-child transmission of HIV, if a woman is on effective HAART and chooses to exclusively breast-feed having carefully considered the aforementioned advice, she should be supported to do so as safely, and for as short a period, as possible.”

At the time of writing these are draft guidelines that are out for consultation. A number of comments were received disagreeing with the proposal to relax the guidelines. The significance is not so much whether these guidelines will be accepted as the fact that the capacity of ARVs to reduce the risk of infection is being considered in other areas of transmission.