Infant feeding: emerging concepts to prevent HIV transmission.

IF 3.6 3区医学 Q2 INFECTIOUS DISEASES

Current Opinion in Infectious Diseases Pub Date : 2024-02-01 Epub Date: 2023-10-27 DOI:10.1097/QCO.0000000000000986

Alasdair Bamford, Caroline Foster, Hermione Lyall

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引用次数: 0

Abstract

Purpose of review: HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART.

Recent findings: Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options.

Summary: Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.

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婴儿喂养：预防艾滋病毒传播的新概念。

综述的目的：妊娠期艾滋病毒筛查、普遍的抗逆转录病毒抑制疗法（ART）和避免母乳喂养几乎可以完全防止艾滋病毒的垂直传播。母乳喂养与额外的传播风险有关，尽管这种风险在抑制性母体抗逆转录病毒疗法中极低。这种最低风险必须与母乳喂养对艾滋病毒感染者及其婴儿的益处相平衡。高收入国家的指导意见已经演变，向支持女性接受抑制性抗逆转录病毒治疗的母乳喂养转变。最近的研究结果：母乳传播在全球新发婴儿感染中所占比例越来越高。大多数传播数据来自包括未接受抑制性ART的女性在内的研究。在病毒载量检测不到的情况下，母乳传播很少发生，尽管风险因素尚不清楚。支持母乳喂养的结果数据正在积累，为指导方针提供证据，并为婴儿喂养决策提供信息。用于母体预存预防或治疗的长效ART和婴儿产后预防是有前景的未来选择。总结：使用抑制性抗逆转录病毒治疗的母乳喂养垂直传播的风险非常低，对WLHIV及其婴儿有多种益处。然而，建议谨慎放宽母乳喂养指导，以免危及到2030年消除垂直传播的全球目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Infectious Diseases 医学-传染病学

CiteScore

6.70

自引率

2.60%

发文量

121

审稿时长

6-12 weeks

期刊介绍： This reader-friendly, bimonthly resource provides a powerful, broad-based perspective on the most important advances from throughout the world literature. Featuring renowned guest editors and focusing exclusively on two topics, every issue of Current Opinion in Infectious Disease delivers unvarnished, expert assessments of developments from the previous year. Insightful editorials and on-the-mark invited reviews cover key subjects such as HIV infection and AIDS; skin and soft tissue infections; respiratory infections; paediatric and neonatal infections; gastrointestinal infections; tropical and travel-associated diseases; and antimicrobial agents.