Abstract
Using antiretroviral medication to prevent transmission of HIV from mother‐to‐child during breastfeeding
Worldwide, the primary cause of human immunodeficiency virus (HIV) infection in children is mother‐to‐child transmission (MTCT). MTCT of HIV can occur during pregnancy, around the time of delivery, or through breastfeeding. Great strides have been made in reducing MTCT during pregnancy and around the time of delivery. However, without intervention, a significant proportion of children born to HIV–infected mothers acquire HIV through breastfeeding.
Where affordable, feasible, acceptable, sustainable, and safe (AFASS) alternatives to breast milk are available, it is recommended that HIV‐infected mothers do not breastfeed. However, for a substantial number of HIV‐infected women in the developing world, complete avoidance of breastfeeding is not AFASS. These mothers are counseled to practice exclusive breastfeeding (giving a child only breast milk and no additional food, water, or other fluids). Provision of antiretrovirals (ARVs) either to the mother or to the child during breastfeeding represent potential interventions to reduce the risk of HIV transmission to breastfeeding children. This review explores the available evidence regarding the efficacy and safety of ARV prophylaxis regimens to reduce breast milk transmission of HIV.