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Women and HIV: Questions Answered |
 
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| August 2007 Issue No. 14 |
The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org | |
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Mother-to-Child Transmission of HIV
What are “MTCT” and “PMTCT”?
MTCT stands for mother-to-child transmission of HIV. It is the term that programs and researchers use to describe HIV transmission from mothers to their infants during pregnancy, childbirth, or breastfeeding. Efforts to reduce this form of HIV transmission are referred to as preventing mother-to-child transmission of HIV, or PMTCT.
What are the chances of mother-to-child transmission (MTCT) of HIV?
If not receiving care, women infected with HIV have a 15% to 30% chance of passing the virus to their infants during pregnancy, labor, or delivery. If these women breastfeed in typical fashion (giving both breastmilk and other liquids or food before six months), breastfeeding will transmit HIV to another 10% to 20% of infants. In other words, for every 20 births of women with HIV, 3 to 6 would be born infected, and another 2 to 4 would be infected if breastfed. Thus, without special care, as few as 3 or as many as 10 in every 20 babies would be infected. If treatment and proper feeding are possible, however, the risks can be reduced (13, 14, 19, 59).
What increases the chances of mother-to-child transmission (MTCT) of HIV?
Women with a lot of virus in their bodies and weakened immune systems are more likely to pass HIV to their infants. If a woman becomes infected with HIV during pregnancy or breastfeeding, the high HIV levels at this stage of infection would make MTCT more likely (26, 32, 52).
Also, STIs and malaria increase the risk of MTCT between two-fold and more than five-fold, compared with the risk among women who have HIV but none of these other conditions (2, 6, 10, 17, 22, 35, 56).
Breast infection (mastitis), breast abscesses, and nipple lesions increase the risk of HIV transmission through breastfeeding. Women with HIV and women who do not know their HIV status should pay extra care and attention to breast health while nursing (also see Population Reports, “Better Breastfeeding, Healthier Lives,” Series 7, Number 14) (20, 35, 79, 95).
Can the chances of mother-to-child transmission (MTCT) be lowered?
Yes. Where available, ARV medications, cesarean-section delivery, and avoidance of breastfeeding, each can reduce MTCT risk. The ARV regimens commonly used in developing countries to reduce MTCT lower the risk by one-third to nearly two-thirds (21, 32, 90, 99).
If a woman with HIV is taking ARVs for her own health, does her regimen need to be changed in any way if she becomes pregnant?
Certain ARV regimens may need to be altered before trying for pregnancy. In particular, there is concern that efavirenz can cause birth defects if taken during pregnancy. Aside from this change, a woman receiving ARVs as ongoing treatment for her own health does not need an additional short course of ARVs during labor, but her infants should be given a single dose of nevirapine plus ziduvodine for one week after birth or, at minimum, a single dose of nevirapine soon after birth (25, 96, 99).
What is the safest way for a woman with HIV to breastfeed?
Unless mothers with HIV can get suitable replacement food for the baby, they should exclusively breastfeed their infants for the first six months of life. Exclusive breastfeeding means giving the baby only breastmilk and no other food or liquid. Then, at six months, the baby should be weaned over a period ranging from two days to three weeks. Compared with six months of mixed feeding (giving both breastmilk and other food), exclusive breastfeeding for six months reduces the risk of MTCT by one-fourth to nearly one-half.
Replacement feeding would eliminate all risk of HIV transmission through breastfeeding, but in low-resource settings, adequate replacement feeding is rarely available (13, 100).
Do ARV medications harm the mother or baby?
The ARVs given as prophylaxis (for disease prevention) during pregnancy to reduce HIV transmission do not cause serious or life-threatening conditions. One ARV used to treat people with HIV, efavirenz, has been shown to cause birth defects, and therefore it is not used to reduce MTCT during pregnancy (25, 38, 43, 90).
Are there any ARV regimens that can help reduce HIV transmission through breastfeeding?
The World Health Organization does not currently recommend giving ARV prophylaxis (for disease prevention) regimens to the mother and/or baby solely to prevent HIV transmission through breastfeeding. A number of studies are underway. So far, it appears that certain ARV combinations do lower HIV levels in breastmilk. Women with HIV who require ARV treatment for their own health and are breastfeeding should continue to take the ARVs (27, 99).
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