A review of evidence for transmission of HIV from children to breastfeeding women and implications for prevention.
BACKGROUND
Child-to-breastfeeding woman transmission (CBWT) of HIV occurs when an HIV-infected infant transmits the virus to an HIV-uninfected woman through breastfeeding. Transmission likely occurs as a result of breastfeeding contact during a period of epithelial disruption, such as maternal skin fissures and/or infant stomatitis. Despite extensive epidemiologic and phylogenetic evidence, however, CBWT of HIV continues to be overlooked.


OBJECTIVE
This article summarizes the available evidence for CBWT from nosocomial outbreaks, during which nosocomially HIV-infected infants transmitted the virus to their mothers through breastfeeding. This article also explores the CBWT risk associated with HIV-infected orphans and their female caretakers, and the lack of guidance regarding CBWT prevention in infant feeding recommendations.


METHODS
We searched online databases including PubMed and ScienceDirect for English language articles published from January 1975 to January 2011 using the search terms "HIV," "perinatal," "child-to-mother" and "breastfeeding." The citations from all selected articles were reviewed for additional studies.


RESULTS
We identified 5 studies documenting cases of CBWT. Two studies contained data on the number of HIV-infected women, as well as the proportion breastfeeding. Rates of CBWT ranged from 40% to 60% among women reporting breastfeeding after their infants were infected.


CONCLUSIONS
Poor infection control practices, especially in areas of high HIV prevalence, have resulted in pediatric HIV infections and put breastfeeding women at risk for CBWT. Current infant feeding guidelines and HIV prevention messages do not address CBWT, and fail to provide strategies to help women reduce their risk of acquiring HIV during breastfeeding.
Division of Parasitic Diseases and Malaria/Center for Global Health, Centers for Disease Control and Prevention, MS A-06. 1600 Clifton Road, Atlanta, GA 30333, USA. isf9@cdc.gov
Kristen M
KM
Little
Peter H
PH
Kilmarx
Allan W
AW
Taylor
Charles E
CE
Rose
Emilia D
ED
Rivadeneira
Steven R
SR
Nesheim
D001942:Breast Feeding / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000517:prevention & control / Q000635:transmission; D005061:Europe, Eastern; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007623:Kazakhstan; D007707:Kyrgyzstan; D008002:Libya; D009035:Mothers / Q000706:statistics & numerical data