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

Rollins, Nigel; Coovadia, Hoosen M.

Current Opinion in HIV and AIDS: September 2013 - Volume 8 - Issue 5 - p 467–473
doi: 10.1097/COH.0b013e3283632ba2

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.

aWorld Health Organization, Geneva, Switzerland

bUniversity of KwaZulu-Natal, Durban, South Africa

cUniversity of the Witwatersrand, Johannesburg, South Africa

Correspondence to Nigel Rollins, Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, Geneva 1211, Switzerland. Tel: +41 022 791 4624; fax: +41 022 791 4853; e-mail:

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