Publications
Partners
Mother-to-child transmission (MTCT) of HIV is one of the major causes of HIV infection in children and, unless preventive measures are taken, up to 40% of children born to HIV-positive women are infected.
MTCT in Australia is very low though it still occurs. These are the current statistics:
• At the end of 2012 of the 24 731 HIV+ people in Australia, women counted for 10% of this figure.
• Between 2003 and 2012 367 children were born to HIV+ mothers, though only 14 were diagnosed with HIV.
• Of the 345 children born to mothers who were diagnosed with HIV prior to their child's birth, seven children were HIV+.
• Of the 12 children born to mothers whose HIV remained undiagnosed at the time of their child's birth, six were diagnosed with HIV.
HIV can be transmitted from an infected mother to her baby either:
• Via the placenta during pregnancy.
• Through blood contamination during childbirth.
• Through breastfeeding.
Why are only some babies of HIV+ women infected and others not?
The transmission of HIV from a mother to her baby depends on many factors, such as the viral load in the mother’s blood at the time of pregnancy (or breastfeeding).
Viral load is very high (and the CD4 count low) shortly after infection (during the acute phase) and again in the final stage of Aids.
A pregnant woman is more likely to transmit the virus to her foetus during pregnancy if she becomes infected just before or during pregnancy (when she is in the acute phase), or if she has Aids (final stage).
The viral load in breast milk is also higher in these phases. HIV can also transmit easier to a baby through breastfeeding if the mother’s nipples are cracked, or if the baby has oral thrush.
HIV-infected pregnant women should always use condoms to prevent re-infection. Any new HIV infection during pregnancy (or while breastfeeding) is likely to result in an increase in the viral load and this will increase the likelihood of MTCT. Re-infection may also cause the mother’s disease to progress more rapidly, leaving the child orphaned sooner.
HIV and breastfeeding
In Australia, as well as most of the developed world, breastfeeding is highly discouraged in the case of maternal HIV due to the risk of infection to the baby.
According to recommendations, HIV+ mothers should avoid breastfeeding in favour of infant formula – as long as it is accessible, affordable, safe, and sustainable.
• AZT (Zidovudine) is rated as Category B3 during pregnancy by the Australian Drug Evaluation Committee, Therapeutic Goods Administration (ADEC TGA).
• There is now good data on AZT use in pregnancy.
• The potential benefits to the mother and fetus far outweigh potential risks to the fetus.
• Breastfeeding is NOT recommended in women with HIV due to the risk of viral transmission through breast milk.
• Formula feeds are preferred.
• However, skin-to-skin contact between mother and baby should still be encouraged.
In conclusion, current guidelines in Australia are for HIV+ women to avoid breastfeeding following the long-held notion that avoidance of breastfeeding by HIV-1-infected women is the only means by which prevention of breastfeeding transmission of HIV-1 can be ensured.
According to the World Health Organisation, counselling and support should be offered to mothers who are aware they are HIV+, while the message that this is one of the few instances in which breastfeeding is contraindicated should be carefully delivered to the general public so the message about the positive effects of breastfeeding is not undermined.
MTCT in Australia is very low though it still occurs. These are the current statistics:
• At the end of 2012 of the 24 731 HIV+ people in Australia, women counted for 10% of this figure.
• Between 2003 and 2012 367 children were born to HIV+ mothers, though only 14 were diagnosed with HIV.
• Of the 345 children born to mothers who were diagnosed with HIV prior to their child's birth, seven children were HIV+.
• Of the 12 children born to mothers whose HIV remained undiagnosed at the time of their child's birth, six were diagnosed with HIV.
HIV can be transmitted from an infected mother to her baby either:
• Via the placenta during pregnancy.
• Through blood contamination during childbirth.
• Through breastfeeding.
Why are only some babies of HIV+ women infected and others not?
The transmission of HIV from a mother to her baby depends on many factors, such as the viral load in the mother’s blood at the time of pregnancy (or breastfeeding).
Viral load is very high (and the CD4 count low) shortly after infection (during the acute phase) and again in the final stage of Aids.
A pregnant woman is more likely to transmit the virus to her foetus during pregnancy if she becomes infected just before or during pregnancy (when she is in the acute phase), or if she has Aids (final stage).
The viral load in breast milk is also higher in these phases. HIV can also transmit easier to a baby through breastfeeding if the mother’s nipples are cracked, or if the baby has oral thrush.
HIV-infected pregnant women should always use condoms to prevent re-infection. Any new HIV infection during pregnancy (or while breastfeeding) is likely to result in an increase in the viral load and this will increase the likelihood of MTCT. Re-infection may also cause the mother’s disease to progress more rapidly, leaving the child orphaned sooner.
HIV and breastfeeding
In Australia, as well as most of the developed world, breastfeeding is highly discouraged in the case of maternal HIV due to the risk of infection to the baby.
According to recommendations, HIV+ mothers should avoid breastfeeding in favour of infant formula – as long as it is accessible, affordable, safe, and sustainable.
• AZT (Zidovudine) is rated as Category B3 during pregnancy by the Australian Drug Evaluation Committee, Therapeutic Goods Administration (ADEC TGA).
• There is now good data on AZT use in pregnancy.
• The potential benefits to the mother and fetus far outweigh potential risks to the fetus.
• Breastfeeding is NOT recommended in women with HIV due to the risk of viral transmission through breast milk.
• Formula feeds are preferred.
• However, skin-to-skin contact between mother and baby should still be encouraged.
In conclusion, current guidelines in Australia are for HIV+ women to avoid breastfeeding following the long-held notion that avoidance of breastfeeding by HIV-1-infected women is the only means by which prevention of breastfeeding transmission of HIV-1 can be ensured.
According to the World Health Organisation, counselling and support should be offered to mothers who are aware they are HIV+, while the message that this is one of the few instances in which breastfeeding is contraindicated should be carefully delivered to the general public so the message about the positive effects of breastfeeding is not undermined.
