New Study on HIV and Breastfeeding Shows Positive Results for Preventing Mother-to-Child Transmission
Posted by
Robert Yule
Washington, D.C.
June 17, 2010
Photo: James Pursey published in today’s New England Journal of Medicine provides important evidence on how mothers living with HIV in resource-poor countries can more safely breastfeed their infants.
Conducted in Lilongwe,
Malawi, the Breastfeeding, Antiretrovirals, and Nutrition (BAN) Study addressed one of the most difficult dilemmas of mother-to-child transmission of HIV: the issue of infant feeding.
While breastfeeding is a key component of infant survival in the developing world, it also poses a risk of HIV infection for infants of HIV-positive mothers. Reconciling these two truths has presented a difficult decision for millions of mothers living with the virus, and also a major challenge to HIV researchers for many years.
The CDC funded the BAN Study through the University of North Carolina at Chapel Hill to determine the effectiveness of two interventions to prevent transmission through breastfeeding:
- providing a triple drug antiretroviral combination regimen to mothers who didn’t need therapy for their own health to reduce the levels of virus in her blood and make transmission less likely; and
- administering preventative daily doses of the antiretroviral drug nevirapine to their infants.
The BAN Study showed that both of these interventions were effective in preventing mother-to-child transmission during the breastfeeding period, in comparison to no interventions using prolonged use of antiretroviral medications.
Earlier studies had looked at either of these mechanisms, but this was the first study to look at both. And the BAN Study was large in scope, enrolling more than 2,300 mother-infant pairs in Malawi.
Previous studies had also looked at infant nevirapine doses for different durations, including 6 weeks (SWEN study) and 14 weeks (PEPI study) after birth. These studies suggested that an increased duration of nevirapine provided greater protection to infants without serious safety concerns. The BAN Study extended this to 28 weeks, and evaluated a different regimen for the mothers.
Some countries such as Botswana and South Africa previously recommended that HIV-positive mothers refrain from breastfeeding, and invested in programs to provide formula for infant feeding. But many began to reconsider these practices after studies showed that infants were more likely to die from malnutrition and diarrheal illnesses while on formula feeding.
The WHO recently revised its own recommendations on infant feeding, and countries are beginning to adopt them. For countries where there are high background rates for infectious diseases and mortality, the new guidelines include breastfeeding for up to 12 months for HIV-positive women along with interventions for either mothers or infants, as suggested by the BAN Study. These guidelines on breastfeeding maximize HIV-free infant survival, avoid stigma because they are more socially acceptable in many resource-poor settings, and are logistically easier and pose fewer health risks than formula feeding.
The BAN Study provides more evidence and information for HIV-positive mothers to safely feed their children, and is a clear benefit to millions of women and children living throughout the developed world.
The BAN Study was built upon the Foundation-supported PMTCT program in Malawi. Foundation Vice President of Research Dr. Laura Guay served as a consultant for the study design, and Foundation Senior Research Officer Emily Bobrow and
Foundation International Leadership Award Winner Dr. Agnes Moses from Malawi both served as investigators on the BAN Study team.
The Foundation was one of the first funders of studies to prevent mother-to-child transmission, and continues to push for and fund a
research agenda to lead to the elimination of pediatric AIDS.
Robert Yule is the Foundation's Media Manager, based in Washington, D.C.