Risk factors for early and late transmission of HIV via breastfeeding among infants born to HIV-infected women in a randomized clinical trial in Bostwana
Introduction
Mother-To-Child-Transmission (MTCT) of Human Immunodefiency Virus (HIV) is of major importance so is its Prevention (Prevention of Mother-To-Child-Transmission of HIV; PMTCT) especially so in Resource-limited settings like most of Sub-Saharan Africa (SSA).
The World Health Organisation (WHO) policy guidelines to help stem MTCT appear inappropriate in a true SSA setting as we shall illustrate below.
The Mashi Study
MTCT can occur through breastfeeding, here we explore how:
1. maternal immunity (CD4 + count);
2. maternal viral loads in blood and breast milk;
3. duration of, and choice of, breast feeding;
4. use of Anti Retro Therapy (ART) as treatment and or prophylaxis (prophylaxis refers to prevention tools, in this case such tools being the ART),
influence MTCT through breast-feeding in SSA using Botswana as a case study as evidenced in a randomized clinical trial- the Mashi study (Mashi means milk in Setswana, the main local dialect in Botswana) by Roger L. Shapiro et al (JID 2009:199), while recognising the predominance of breast-feeding as the preferred infant feeding option for both HIV infected and non-infected mothers in SSA.
This study is crucial as it may influence policy guidelines where formula-feeding (with an excess risk of infant mortality), short duration breast-feeding, ART and PMTCT programmes co-exist.
This is because it was found that maternal HIV viral loads in breast-milk and blood (Viral loads refers to the absolute level of HIV in the desired body tissue or fluid) predicted late MTCT, thereby suggesting that short duration( one month) breast feeding in combination with maternal and infant ART use was optimal for PMTCT via breast-feeding.
The Mashi study involved four sites in Botswana recruiting 1200 HIV-infected mothers and their infants who...