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Non-antiretroviral Approaches to Prevention of Breast Milk Transmission of HIV-1: Exclusive Breastfeeding, Early Weaning, Treatment of Expressed Breast Milk

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Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 743))

Abstract

Identification of risk factors for breast milk transmission of HIV has led to the development of interventions to prevent such transmission [1]. Mixed feeding of an infant, i.e., provision of other fluids and/or solids to the infant in addition to breast milk, has been associated with an increased risk of mother-to-child transmission of HIV [2, 3]. Therefore, exclusive breastfeeding of the infant has been emphasized, not only for the benefits such feeding provides to infants in general [4–7], but also specifically to prevent mother-to-child transmission of HIV [8]. The longer the duration of exposure to breast milk from an HIV-infected woman, the greater the transmission of HIV to the infant [9]. Although complete avoidance of breastfeeding has been shown to be efficacious in preventing breast milk transmission of HIV [10], such an intervention is not feasible in many settings. Therefore, the concept of early weaning from breastfeeding was developed, and this intervention has been evaluated [11]. The higher the maternal HIV RNA concentration (viral load), including viral load in breast milk, the greater the HIV transmission to the infant [12–15]. Treatment of expressed breast milk with microbicidal agents or with heat to decrease breast milk viral load, and thus decrease mother-to-child transmission of HIV, has been evaluated [16, 17]. This chapter reviews these three approaches to the prevention of breast milk transmission of HIV: exclusive breastfeeding, early weaning, and treatment of expressed breast milk.

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References

  1. Read JS (2003) Human milk, breastfeeding, and transmission of human immunodeficiency virus type 1 in the United States. Pediatrics 112(5):1196–1205

    Article  PubMed  Google Scholar 

  2. Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM (2001) Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durham, South Africa. AIDS 15:379–387

    Article  PubMed  CAS  Google Scholar 

  3. Iliff P, Piwoz E, Tavengwa N et al (2005) Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-1-free survival. AIDS 19:699–708

    Article  PubMed  Google Scholar 

  4. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355:451–455

    Google Scholar 

  5. Victora CG, Smith PG, Vaughan JP et al (1987) Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet 2:319–322

    Article  PubMed  CAS  Google Scholar 

  6. Brown KH, Black RE, Lopz de Romana G, Creed de Kanashiro H (1989) Infant-feeding practices and their relationship with diarrheal and other diseases in Huascar (Lima), Peru. Pediatrics 83:31–40

    PubMed  CAS  Google Scholar 

  7. Koyanagi A, Humphrey JH, Moulton LH et al (2009) Effect of early exclusive breastfeeding on morbidity among infants born to HIV-1-negative mothers in Zimbabwe. Am J Clin Nutr 89(5):1375–1382

    Article  PubMed  CAS  Google Scholar 

  8. Coovadia HM, Rollins NC, Bland RM et al (2007) Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 369:1107–1116

    Article  PubMed  Google Scholar 

  9. Breastfeeding and HIV-1 International Transmission Study Group (2004) Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis 189:2154–2166

    Article  Google Scholar 

  10. Nduati R, John G, Mbori-Ngacha D et al (2000) Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA 283:1167–1174

    Article  PubMed  CAS  Google Scholar 

  11. Kuhn L, Aldrovandi GM, Sinkala M et al (2008) Effects of early, abrupt weaning for HIV-1-free survival of children in Zambia. N Engl J Med 359:130–141

    Google Scholar 

  12. Semba RD, Kumwenda N, Hoover DR et al (1999) Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 180:93–98

    Article  PubMed  CAS  Google Scholar 

  13. Richardson BA, John-Stewart GC, Hughes JP et al (2003) Breast-milk infectivity in human immunodeficiency virus type 1-infected mothers. J Infect Dis 187:739–740

    Article  Google Scholar 

  14. Pillay K, Coutsoudis A, York D, Kuhn L, Coovadia HM (2000) Cell-free virus in breast milk of HIV-1-seropositive women. J Acquir Immune Defic Syndr 24:330–336

    PubMed  CAS  Google Scholar 

  15. Rousseau CM, Nduati RW, Richardson BA et al (2003) Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 187:741–747

    Article  PubMed  Google Scholar 

  16. Urdaneta S, Wigdahl B, Neely EB et al (2005) Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium docecyl sulfate (SDS). Retrovirology 2:28

    Article  PubMed  Google Scholar 

  17. Israel-Ballard K, Donovan R, Chantry C et al (2007) Flash-heat inactivation of HIV-1 in human milk. J Acquir Immune Defic Syndr 45(3):318–323

    PubMed  Google Scholar 

  18. Tess BH, Rodrigues LC, Newell M-L, Dunn DT, Lago TDG (1998) Infant feeding and risk of mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. Sao Paulo Collaborative Study for Vertical Transmission of HIV-1. J Acquir Immune Defic Syndr Hum Retrovirol 19(2):189–194

    Article  PubMed  CAS  Google Scholar 

  19. Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM (1999) Influence of infant feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa. Lancet 354:471–476

    Article  PubMed  CAS  Google Scholar 

  20. Kuhn L, Sinkala M, Kankasa C et al (2007) High uptake of exclusive breastfeeding and reduced early post-natal HIV-1 transmission. PLoS One 2(12):e1363

    Article  PubMed  Google Scholar 

  21. Kuhn L (2010) Milk mysteries: why are women who exclusively breast feed less likely to transmit HIV-1 during breast-feeding? [editorial]. Clin Infect Dis 50:770–772

    Article  PubMed  Google Scholar 

  22. Kasonka L, Makasa M, Marshall T et al (2006) Risk factors for subclinical mastitis among HIV-1-infected and uninfected women in Lusaka, Zambia. Paediatr Perinat Epidemiol 20(5):379–391

    Article  PubMed  Google Scholar 

  23. Rollins NC, Filteau SM, Coutsoudis A, Tomkins AM (2001) Feeding mode, intestinal permeability, and neopterin excretion: a longitudinal study in infants of HIV-1-infected South African women. J Acquir Immune Defic Syndr 28(2):132–139

    PubMed  CAS  Google Scholar 

  24. Lunney KM, Iliff P, Mutasa K et al (2010) Associations between breast milk viral load, mastitis, exclusive breast-feeding, and postnatal transmission of HIV-1. Clin Infect Dis 50:762–769

    PubMed  Google Scholar 

  25. Chisenga M, Kasonka L, Makasa M et al (2005) Factors affecting the duration of exclusive breastfeeding among HIV-1-infected and -uninfected women in Lusaka, Zambia. J Hum Lact 21(3):266–275

    Article  PubMed  Google Scholar 

  26. Phiri W, Kasonka L, Collin S et al (2006) Factors influencing breast milk HIV-1 RNA viral load among Zambian women. AIDS Res Hum Retroviruses 22(7):607–614

    Article  PubMed  CAS  Google Scholar 

  27. Guay LA, Musoke P, Fleming T et al (1999) Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIV-1NET 012 randomised trial. Lancet 354:795–802

    PubMed  CAS  Google Scholar 

  28. Thea DM, Aldrovandi G, Kankasa C et al (2006) Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume. AIDS 20(11):1539–1547

    Article  PubMed  CAS  Google Scholar 

  29. Kuhn L, Aldrovandi Gm, Sinkala M et al (2009) Differential effects of early weaning for HIV-1-free survival of children born to HIV-1-infected mothers by severity of maternal disease. PLoS One 4(6):e6059. doi:10.1371/journal.pone.0006059

  30. Kuhn L, Sinkala M, Semrau K et al (2010) Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-1-infected mothers. Clin Infect Dis 50:437–444

    Article  PubMed  Google Scholar 

  31. Kesho Bora Study Group (2011) Safety and effectiveness of antiretroviral drugs during pregnancy, delivery and breastfeeding for prevention of mother-to-child transmission of HIV-1: the Kesho Bora multicentre collaborative study rational, design, and implementation challenges. Contemp Clin Trials 32:74–85

    Article  Google Scholar 

  32. Mbori-Ngacha D, Nduati R, John G et al (2001) Morbidity and mortality in bresatfed and formula-fed infants of HIV-1-infected women: a randomized clinical trial. JAMA 286(19):2413–2420

    Article  PubMed  CAS  Google Scholar 

  33. Becquet R, Bequet L, Ekouevi DK et al (2007) Two-year morbidity-mortality and alternatives to prolonged breast-feeding among children born to HIV-1-infected mothers in Cote d’Ivoire. PLoS Med 4(1):317. doi:10.1371/journal.pmed.0040017

    Google Scholar 

  34. Kagaayi J, Gray RH, Brahmbhatt H et al (2008) Survival of infants born to HIV-1-positive mothers, by feeding modality, in Rakai, Uganda. PLoS ONE 3(12):e3877. doi:10.1371/journal.pone.0003877

  35. Harris JR, Greene SK, Thomas TK et al (2009) Effect of a point-of-use water treatment and safe water storage intervention on diarrhea in infants of HIV-1-infected mothers. J Infect Dis 200:1186–1193

    Article  PubMed  Google Scholar 

  36. Kafulafula G, Hoover DR, Taha TE et al (2010) Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-1-infected women in Malawi. J Acquir Immune Defic Syndr 53(1):6–13

    Article  PubMed  Google Scholar 

  37. Onyango-Makumbi C, Bagenda D et al (2010) Early weaning of HIV-1-exposed uninfected infants and risk of serious gastroenteritis: findings from two perinatal prevention trials in Kampala, Uganda. J Acquir Immune Defic Syndr 53(1):20–27

    Article  Google Scholar 

  38. Creek TL, Kim A, Lu L et al (2010) Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. J Acquir Immune Defic Syndr 53(1):14–19

    Article  PubMed  Google Scholar 

  39. Homsy J, Moore D, Barasa A et al (2010) Breastfeeding, mother-to-child HIV-1 transmission, and mortality among infants born to HIV-1-infected women on highly active antiretroviral therapy in rural Uganda. J Acquir Immune Defic Syndr 53(1):28–35

    Article  PubMed  Google Scholar 

  40. World Health Organization. Guidelines on HIV-1 and infant feeding 2010. http://whqlibdoc.who.int/publications/2010/9789241599535_eng.pdf. Accessed 1 Apr 2011

  41. Hartmann SU, Wigdahl B, Neely EB, Berlin CM, Schengrund C-L, Lin H-M, Howett MK (2006) Biochemical analysis of human milk treated with sodium dodecyl sulfate, an alkyl sulfate microbicide that inactivates human immunodeficiency virus type 1. J Hum Lact 22(1):61–74

    Article  PubMed  Google Scholar 

  42. Urdaneta S, Wigdahl B, Neely EB et al (2005) Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium dodecyl sulfate (SDS). Retrovirology 2:28

    Article  PubMed  Google Scholar 

  43. Chantry CJ, Morrison P, Panchula J et al (2000) Effects of lipolysis or heat treatment on HIV-1 provirus in breast milk. J Acquir Immune Defic Syndr 24:325–329

    PubMed  CAS  Google Scholar 

  44. Orloff SL, Wallingford JC, McDougal JS (1993) Inactivation of human immunodeficiency virus type 1 in human milk: effects of intrinsic factors in human milk and of pasteurization. J Hum Lact 9:13–17

    Article  PubMed  CAS  Google Scholar 

  45. Ford JE, Law BA, Marshall VM, Reiter B (1977) Influence of the heat treatment of human milk on some of its protective constituents. J Pediatr 90:29–35

    PubMed  CAS  Google Scholar 

  46. Jorgensen AF, Boisen F (2000) Pasteurization of HIV-1 contaminated breast milk. In: Proceedings and abstracts of the XIII world AIDS conference, Durban, South Africa, July 2000; abstract LbPp122

    Google Scholar 

  47. Jeffery BS, Mercer KG (2000) Pretoria pasteurization: a potential method for the reduction of postnatal mother to child transmission of the human immunodeficiency virus. J Trop Pediatr 46:219–223

    Article  PubMed  CAS  Google Scholar 

  48. Jeffery BS, Webber L, Mokhondo KR, Erasmus D (2001) Determination of the effectiveness of inactivation of human immunodeficiency virus by pretoria pasteurization. J Trop Pediatr 47:345–349

    Article  PubMed  CAS  Google Scholar 

  49. Jeffery BS, Soma-Pillay P, Makin J, Moolman G (2003) The effect of Pretoria pasteurization on bacterial contamination of hand-expressed human breast milk. J Trop Pediatr 49(4):240–244

    Article  PubMed  CAS  Google Scholar 

  50. Israel-Ballard K, Chantry C, Dewey K et al (2005) Viral, nutritional, and bacterial safety of flash-heated and pretoria-pasteurized breast milk to prevent mother-to-child transmission of HIV-1 in resource-poor countries: a pilot study. J Acquir Immune Defic Syndr 40:175–181

    Article  PubMed  Google Scholar 

  51. Volk ML, Hanson CV, Israel-Ballard K, Chantry CJ (2010) Inactivation of cell-associated and cell-free HIV-1 by flash-heat treatment of breast milk [letter]. J Acquir Immune Defic Syndr 53(5):665–666

    Article  PubMed  Google Scholar 

  52. Israel-Ballard KA, Abrams BF, Coutsoudis A, Sibeko LN, Cheryk LA, Chantry CJ (2008) Vitamin content of breast milk from HIV-1-infected mothers before and after flash-heat treatment. J Acquir Immune Defic Syndr 48(4):444–449

    Article  PubMed  CAS  Google Scholar 

  53. Chantry CJ, Israel-Ballard K, Moldoveanu Z et al (2009) Effect of flash-heat treatment on immunoglobulins in breast milk. J Acquir Immune Defic Syndr 51(3):264–267

    Article  PubMed  CAS  Google Scholar 

  54. Chantry CJ, Wiedeman J, Buehring G et al (2011) Effect of flash-heat treatment on antimicrobial activity of ­breast milk. Breastfeed Med 6(3):111–116

    Google Scholar 

  55. Israel-Ballard KA, Maternowska MC, Abrams BF et al (2006) Acceptability of heat treating breast milk to prevent mother-to-child transmission of human immunodeficiency virus in Zimbabwe: a qualitative study. J Hum Lact 22(1):48–60

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Global Health Sciences, University of California, 50 Beale Street, Suite 1200, San Francisco, CA, 94105, USA

    Jennifer S. Read M.D., M.S., M.P.H., D.T.M.H.

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  1. Jennifer S. Read M.D., M.S., M.P.H., D.T.M.H.
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Correspondence to Jennifer S. Read M.D., M.S., M.P.H., D.T.M.H. .

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Editors and Affiliations

  1. School of Medicine, Emory University, Buford Highway 4770, Atlanta, 30341, Georgia, USA

    Athena P. Kourtis

  2. and Prevention, Global AIDS Program - China, Centers for Disease Control, Emory University School of Medicine, Beijing, 100600, China, People's Republic

    Marc Bulterys

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Read, J.S. (2012). Non-antiretroviral Approaches to Prevention of Breast Milk Transmission of HIV-1: Exclusive Breastfeeding, Early Weaning, Treatment of Expressed Breast Milk. In: Kourtis, A., Bulterys, M. (eds) Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding. Advances in Experimental Medicine and Biology, vol 743. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2251-8_14

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  • DOI: https://doi.org/10.1007/978-1-4614-2251-8_14

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