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Correspondence

Indian Pediatr 2016;53: 534

Effective Prevention of Parent-to- Child Transmission of HIV

 

Pandiarajan Vignesh and *Deepti Suri

Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Center, PGIMER, Chandigarh,India.
Email: [email protected]

 


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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