Postnatal HIV Transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis

Abstract

Introduction: to systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the WHO infant feeding guidelines in the context of HIV and ART.

Methods: we reviewed experimental and observational studies; exposure was maternal HIV antiretroviral therapy (and duration) and infant feeding modality; outcomes were overall and postnatal HIV transmission rates in the infant at 6, 9, 12 and 18 months. English literature from 2005 to 2015 was systematically searched in multiple electronic databases. Papers were analysed by narrative synthesis; data were pooled in random effects meta-analyses. Postnatal transmission was assessed from 4-6 weeks of life. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE.

Results and discussion: eleven studies were identified, from 1439 citations and review of 72 abstracts. Heterogeneity in study methodology and pooled estimates was considerable. Overall pooled transmission rates at 6 months for breastfed infants with mothers on ART was 3.54% (95 confidence interval, CI, 1.15-5.93%) and at 12 months 4.23% (95% CI 2.97-5.49%). Postnatal transmission rates were 1.08 (95% CI: 0.32-1.85) at six and 2.93 (95%CI: 0.68-5.18) at 12 months. ART was mostly provided for PMTCT only and did not continue beyond 6 months postpartum. No study provided data on mixed feeding and transmission risk.

Conclusions: there is evidence of substantially reduced postnatal HIV transmission risk under the cover of maternal ART. However, transmission risk increased once PMTCT ART stopped at 6 months, which supports the current WHO recommendations of life-long ART for all

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ORCID for Marie-Louise Newell: orcid.org/0000-0002-1074-7699

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