New research has raised the possibility of safer breast-feeding by HIV-positive mothers in the developing world, an advance that could save millions of lives.
Programs aimed at preventing mother-to-child transmission of the AIDS virus in poor countries only treat mothers during pregnancy and up to a week after childbirth. Babies are often given a single dose of an AIDS drug at birth. That halves the risk of the babies getting HIV, but many of those gains are lost when the infants later contract the virus through breast-feeding.
Experts say findings presented Tuesday at the biggest AIDS research conference of the year indicate that giving babies a daily AIDS drug from birth through the entire breast-feeding period could significantly reduce the rate of HIV infection through breast milk.
Women with HIV in developed countries are advised not to breast-feed, even though doctors believe potent drug combinations can drastically reduce the risk of spreading the disease from mother to baby.
However, specialists say persuading mothers in poor countries not to breast-feed is impractical -- they can't afford or find infant formula, and women who do not breast-feed are stigmatized because such unusual behavior raises suspicions of HIV infection.
In the study, conducted in Uganda and Rwanda, 397 infants were given syrup containing one of two common AIDS drugs daily for up to six months. Only 1 percent of the babies contracted HIV through breast milk. That compares to a rate of about 15 percent when babies do not receive such treatment, according to lead researcher Dr. Joep Lange of the University of Amsterdam Academic Medical Center.
The study is the first to demonstrate that giving babies antiretroviral medications for up to six months can prevent them from contracting HIV from their mothers through breast milk.
Experts say that if mothers in poor countries received long-term treatment for their HIV, as they do in the developed world, the risk of passing the virus on to their babies through breast milk would be minimal.
"Obviously, it would be much better to [continue to] treat the mothers," said Lange, adding that the treatment of babies is a stop gap until long-term therapy is widely available to everyone in poor countries.
"You have to see this as an intermediate stage," he said, explaining that the study aimed to deliver a simple treatment for the children.
Dr. Francois Dabis, a professor of epidemiology at the French national AIDS research agency who was not connected with the study, said the findings were encouraging but that more research is needed before such a strategy should be widely adopted.
"In this study they limited breast-feeding to about three to four months, which is relatively short," he said, adding that the rate of transmission might have been higher had the mothers breast-fed longer.