Reduction of mother to child HIV-1 transmission: breastfeeding negates benefits of short course regimens

‘Short course regimens to prevent mother-to-child transmission of HIV-1 in less-developed countries should be accompanied by interventions to minimise the risk of subsequent transmission via breastfeeding’

Antiretrovirals and elective caesarean sections have successfully reduced mother-to-child HIV-1 transmission rates in the more-developed world. With limited resources in the less-developed world, short-course anti-retroviral regimens are the most feasible option to reduce transmission to a minimum. The Petra study team did a randomised controlled trial to assess the efficacy of different regimens with zidovudine and lamivudine in 1797 women. They report two regimens that were effective in reducing HIV-1 transmission up to week 6 after birth; however, the benefits had diminished considerably after 18 months of follow-up. These results emphasise the importance of including interventions to reduce the risk of vertical transmission via breastfeeding.

In a Commentary (see below), Karen Beckerman adds that instead of inducing resistance to AIDS therapies, prophylaxis against mother-to-child transmission must be linked to preventing the creation of orphans.