Dear Doctor;

What risk does an HIV+ mother pose to their breastfeeding baby? Does the HIV exist in breast milk? Kellen

Dear Kellen,

HIV is an infection caused by the human immune deficiency virus (HIV). It is called so because it gradually weakens the immune system, making one vulnerable to various infections. HIV is transmitted through various body fluids from an infected person to unaffected one, including breast milk.

An HIV-positive mother can infect her baby either during pregnancy or during delivery or subsequently after delivery if there is no active intervention. Unfortunately, 15-25 per cent of women can infect the babies during pregnancy or delivery and additional 5-20 of infants can become infected during breast feeding. The risk depends on factors like duration of HIV infection of the mother, her immune status, her overall health status, whether she takes anti-retroviral therapy or not and any repeat exposure. Cracked or fissured nipples, cracked breast tissue, mastitis (inflammation of the breast tissue) are other risk factors which facilitate the transmission of HIV virus to the baby through breast milk. Newly infected mothers are at greater risk of transmitting infection to their babies, as compared to one, who is already on antiretroviral therapy. The newborn baby is tested at birth and then 4 to 6 weeks later. Another test done at 18 months helps to determine whether baby is infected or not.

In third world countries, preventing mother to child transmission is a challenge because many women do not have access to good health facilities, lack access to clean water to prepare formula feeds, are ignorant about the importance of HIV testing during pregnancy and if positive to take ARV drugs regularly to improve immune status of self and prevent infecting the unborn child. However, in Rwanda, due to extensive education among masses regarding HIV/AIDS, good management and coordination among health care providers regarding PMTCT (prevention of mother to child transmission) measures, it has been shown that transmission of HIV from positive mothers to infants can be reduced. The HIV-free survival rate amongst children aged 9-24 months born to HIV positive mothers was 93%, if these mothers were accessing treatment and care through the National PMTCT programme (Ministry of Health, TRACPlus 2011) .