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Indian Pediatr 2016;53: 534 |
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Effective Prevention of Parent-to- Child
Transmission of HIV
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Pandiarajan Vignesh and *Deepti Suri
Allergy Immunology Unit, Department of Pediatrics,
Advanced Pediatrics Center, PGIMER, Chandigarh,India.
Email: [email protected]
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We read the recent article in Indian Pediatrics by Seenivasan, et al.
[1], with great interest. The authors inferred and suggested that the
perinatal transmission detected by polymerase chain reaction (PCR)
positivity at 6 weeks in three infants was secondary to intrapartum
transmission and could not be attributed to breastfeeding alone. Though
risk of transmission increases with duration of breastfeeding, it has
been well reported in literature that transmission of human
immunodeficiency virus (HIV) through breastmilk can occur even as early
as six weeks [2,3]. Moreover, during early stages of breastfeeding,
infants may be at increased risk of infectivity due to factors such as
immaturity of immune system, increased permeability of gut, or high HIV
load in colostrum [4]. In a randomized control study by Nduati, et al.
[2], there was 10% increase of cumulative risk in breastfed infants for
developing HIV infection when compared to formula-fed infants, even at 6
weeks [2]. SAINT trial group inferred that breastfed infants are twice
at risk of HIV infection compared to non breastfed infants during the
first four weeks [3]. Hence, attributing HIV DNA PCR positivity to
intrapartum transmission alone may not be prudent.
It is interesting to note that HIV transmission was
prevented even in mothers with advanced clinical disease. The important
factor, as also stated by the authors, could be the introduction of
triple anti-retroviral therapy (ART). However, it may also be important
if the authors could furnish the details regarding mode of delivery,
associated sexual transmitted infections, and various obstetric factors
known to influence HIV transmission among the three groups of HIV
positive mothers. It is a well known fact that elective cesarean
delivery prior to rupture of membranes reduces the risk of HIV
transmission by nearly 50% compared to vaginal delivery [5]. Hence, if
those confounding variables are equally distributed among the groups,
then ART can be singularly taken as the protective factor.
References
1. Seenivasan S, Vaitheeswaran N, Seetha V,
Anbalagan S, Karunaianantham, et al. Outcome of prevention of
parent-to-child transmission of HIV in an urban population in
Southern India. Indian Pediatr. 2015;52:759-62.
2 . Nduati R, John G, Mbori-Ngacha D, Richardson
B, Overbaugh J, Mwatha A, et al. Effect of breastfeeding and
formula feeding on transmission of HIV-1: A randomized clinical
trial. JAMA. 2000;283:1167-74.
3. Moodley D, Moodley J, Coovadia H, Gray G,
McIntyre J, Hofmyer J, et al. A multicenter randomized
controlled trial of nevirapine versus a combination of zidovudine
and lamivudine to reduce intrapartum and early postpartum
mother-to-child transmission of human immunodeficiency virus type 1.
J Infect Dis. 2003;187:725-35.
4. Dunn DT, Tess BH, Rodrigues LC, Ades AE.
Mother-to-child transmission of HIV: Implications of variation in
maternal infectivity. AIDS Lond Engl. 1998;12:2211-6.
5. McGowan JP, Shah SS. Management of HIV
infection during pregnancy. Curr Opin Obstet Gynecol.
2000;12:357-67.
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