Breastfeeding and HIV transmission in the developing world: past, present, future.

PURPOSE OF REVIEW: In the past 5 years, research has identified antiretroviral drug interventions that significantly reduce HIV transmission through breastfeeding. This evidence is reflected in WHO guidelines that now recommend national health authorities to adopt a public health approach for HIV and infant feeding, namely to promote and support a single infant feeding practice to all HIV-infected mothers. In most developing countries where diarrhoea, pneumonia and malnutrition are common causes of infant mortality, this means breastfeeding and providing antiretroviral drugs. Scaling-up these approaches is essential to eliminate new paediatric infections and to improve maternal health. The review examined knowledge and implementation of these interventions, and considered areas for future research. RECENT
FINDINGS: Most recent reports focus on approaches for resolving implementation challenges rather than investigating new clinical interventions. Wherever WHO guidelines have been implemented, significant reductions in HIV transmission and improved survival are reported. Health system inefficiencies and social barriers continue to impede progress. A limited number of studies examined mechanisms of transmission and how breastmilk and viral factors influence these processes.
SUMMARY: The findings of recent research should give confidence to health workers and policy makers that major improvements in HIV-related child and maternal mortality are attainable and justify intensified efforts.