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

Postnatal HIV Transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis
Postnatal HIV Transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis
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
1758-2652
1-8
Bispo, Stephanie
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Chikhungu, Lana
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Rollins, Nigel
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Siegfried, Nandi
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Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Bispo, Stephanie
a12791e9-146e-4588-91b3-4ef2d77d7f6d
Chikhungu, Lana
fee4094c-4df0-41d9-bfae-947f32519a11
Rollins, Nigel
79b9cfdb-4a6b-44c1-89d9-dbe948a09167
Siegfried, Nandi
f5f4b7d1-ae36-44ac-a433-1034173d0d27
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3

Bispo, Stephanie, Chikhungu, Lana, Rollins, Nigel, Siegfried, Nandi and Newell, Marie-Louise (2017) Postnatal HIV Transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. Journal of the International AIDS Society, 20 (1), 1-8. (doi:10.7448/IAS.20.1.21251).

Record type: Article

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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Stephanie B Manuscript - JIAS-02.12.17.docx - Accepted Manuscript
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Bispo et al Paper Transmission - JIAS - Version of Record
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Stephanie B Supplementary Tables-JIAS.docx - Other
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More information

Accepted/In Press date: 26 January 2017
e-pub ahead of print date: January 2017
Published date: January 2017
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 405409
URI: https://eprints.soton.ac.uk/id/eprint/405409
ISSN: 1758-2652
PURE UUID: b00f5b48-20a5-4b1d-8eac-7a7d0869107a
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 02 Feb 2017 11:27
Last modified: 15 Aug 2019 00:34

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Contributors

Author: Stephanie Bispo
Author: Lana Chikhungu
Author: Nigel Rollins
Author: Nandi Siegfried

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