Page 332 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 7 Original Research

Peripartum HIV infection in very low birth weight

infants fed ‘raw’ mother’s own milk

Authors: Background: HIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at
Melantha Coetzee high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received
1,2
Suzanne D. Delport
2,3
formula to prevent breast milk related HIV transmission. This denied them the benefits of
Affiliations: breast milk, thus exposing the infant to the risk of necrotising enterocolitis (NEC). From 2010,
1 Department of Paediatrics ‘raw’ mother’s own milk (rMOM) has been recommended for term infants whose mothers’
and Child Health, Steve Biko received antenatal antiretroviral therapy (ART). At the same time, the infant received
Academic Hospital, Pretoria,
South Africa antiretroviral (ARV) prophylaxis as per the National Prevention of MTCT programme.
Objectives: To determine the cumulative incidence of peripartum HIV infection by 4–6 weeks
2 Faculty of Health Sciences,
University of Pretoria, of age in HIV-exposed VLBW infants, who received rMOM and infant ARV prophylaxis.
Pretoria, South Africa Method: A retrospective, observational audit over 3 years at a single institution was undertaken.
3 Division of Neonatology, The study population comprised HIV-exposed VLBW infants who received both nevirapine
Department of Paediatrics, prophylaxis and rMOM from birth until discharge. A positive HIV-PCR by 4–6 weeks of life
Kalafong Provincial Tertiary was used to confirm maternal to infant HIV transmission.
Hospital, Pretoria,
South Africa Results: Of the 80 eligible infants admitted between 2010 and 2013, 63 (79%) were exposed to
antenatal ART. Seventy-eight (97.5%) tested HIV-PCR negative at 4–6 weeks. Of the two infants
Corresponding author: who tested positive, both presented with features of an acute HIV infection. The absence of
Melantha Coetzee,
[email protected] MTCT in the remaining 78 infants given ARV prophylaxis and rMOM suggests that rMOM is
an unlikely source of infection in the two infected infants.
Dates:
Received: 15 Sept. 2018 Conclusion: rMOM, in the presence of infant prophylaxis, was a safe feeding option for HIV-
Accepted: 15 Apr. 2019 exposed VLBW infants. It should be strongly considered for these infants, as rMOM likely
Published: 19 June 2019 provides additional maternal and child benefits.
How to cite this article: Keywords: HIV; Prevention of mother-to-child transmission; Mother-to-child transmission;
Coetzee M, Delport SD. Very low birth weight; Peripartum transmission; Mother’s own milk; Raw breast milk;
Peripartum HIV infection in
very low birth weight infants Nevirapine.
fed ‘raw’ mother’s own milk.
S Afr J HIV Med. 2019;20(1),
a912. https://doi.org/ Introduction
10.4102/sajhivmed.v20i1.912
South Africa is the global epicentre of the human immunodeficiency virus (HIV) pandemic, with an
Copyright: antenatal prevalence of 31%. Human immunodeficiency virus-infected women are at increased risk
1
© 2019. The Authors. 2
Licensee: AOSIS. This work of delivering low birth weight and/or preterm infants and of transmitting infection to their infants.
is licensed under the HIV transmission is higher in the absence of maternal antiretroviral therapy (ART); 3,4,5,6 greater with
Creative Commons higher maternal viral load; greater with worsening immunosuppression (low CD4 count); 3,4,6 and is
Attribution License. increased in the presence of maternal infections such as tuberculosis and sexually transmitted
disease. Increased permeability of the intestinal mucosal barrier in preterm infants further increases
7
the risk of mother-to-child transmission (MTCT). These infants are also at risk of necrotising
4,6
enterocolitis (NEC) if formula feeds are administered in an effort to reduce MTCT. Mother’s own
8
milk (MOM) is crucial to the survival of preterm infants. The risk and benefit to VLBW HIV-exposed
9
infants receiving prevention of mother-to-child transmission (PMTCT) interventions and ‘raw’
MOM (rMOM) is unclear. Preterm and VLBW infants receiving rMOM have fewer infections and
less NEC. Whether this is true for HIV-exposed preterm and VLBW infants has not been studied.
8,9
PMTCT programmes in South Africa before 2002 were limited because of governmental AIDS
denialism and concerns related to ART toxicity. In 2002, a Constitutional Court ruling mandated
10
11
Read online: rolling-out of a PMTCT programme. Reports of MTCT of HIV in VLBW infants followed, 12,13,14,15,16,17
Read online:
Scan this QR
Scan this QR but these failed to determine the safest feeding choice in such infants. The feeding regimens in these
code with your studies included exclusive formula feeding (EFF) in line with the National PMTCT programme at the
code with your
smart phone or
smart phone or
mobile device
mobile device time, 18,19 exclusive donor breast milk (DBM) (holder pasteurised) and heat-treated MOM (Pretoria
to read online.
to read online.
pasteurised or flash-heated). 20,21
http://www.sajhivmed.org.za 325 Open Access