Human immunodeficiency virus in newborn of infected mothers: Pregnancy, breast feeding and prevention

The worldwide pandemic of human immunodeficiency virus (HIV) casts its shadow on childbirth, especially in developing countries, where the estimated rate of vertical transmission is 15%-40%, compared with 15%-25% in developed countries. To date, a total number of 90 children younger than 12 years of age are infected with the virus in Israel, and during the years 2001-2003, an average of 29 mothers living with AIDS gave birth annually. Mother-to-child transmission (MTCT) of HIV can occur during pregnancy, in the intrapartum period or postnatally, through breastfeeding. One third of all the breastfed newborn acquire the infection postnatally. HIV can penetrate through the damaged gastrointestinal mucosa into the newborn blood system. Risk increases during gastrointestinal infections and oral skin lesions. MTCT rate is 3.2 to 100 child years, especially if the mother is infected just before or after labor. Antiretroviral therapy during pregnancy and labor, and throughout the first 6 weeks of life in newborn may reduce MTCT by 3-folds. Further avoidance of breastfeeding lowers MTCT to 1%-2%. Most HIV infected women who gave birth in Israel originated from endemic countries. As breastfeeding is the preferred option in traditional cultures, early waning and alternative strategy of supplying substitutes is unique. This recommendation should be combined with medical follow-up for both the mother and her offspring, as well as psychosocial intervention, if needed.