Original Research

Peripartum HIV infection in very low birth weight infants fed ‘raw’ mother’s own milk

Melantha Coetzee, Suzanne D. Delport
Southern African Journal of HIV Medicine | Vol 20, No 1 | a912 | DOI: https://doi.org/10.4102/sajhivmed.v20i1.912 | © 2019 Melantha Coetzee, Suzanne Dirkie Delport | This work is licensed under CC Attribution 4.0
Submitted: 15 September 2018 | Published: 19 June 2019

About the author(s)

Melantha Coetzee, Department of Paediatrics and Child Health, Steve Biko Academic Hospital, Pretoria, South Africa; and, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Suzanne D. Delport, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and, Division of Neonatology, Department of Paediatrics, Kalafong Provincial Tertiary Hospital, Pretoria, South Africa


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Abstract

Background: HIV-exposed very low birth weight (VLBW) infants (≤ 1500 g) are considered at high risk of peripartum mother-to-child HIV transmission (MTCT). In the past, they received formula to prevent breast milk related HIV transmission. This denied them the benefits of breast milk, thus exposing the infant to the risk of necrotising enterocolitis (NEC). From 2010, ‘raw’ mother’s own milk (rMOM) has been recommended for term infants whose mothers’ received antenatal antiretroviral therapy (ART). At the same time, the infant received antiretroviral (ARV) prophylaxis as per the National Prevention of MTCT programme.

Objectives: To determine the cumulative incidence of peripartum HIV infection by 4–6 weeks of age in HIV-exposed VLBW infants, who received rMOM and infant ARV prophylaxis.

Method: A retrospective, observational audit over 3 years at a single institution was undertaken. The study population comprised HIV-exposed VLBW infants who received both nevirapine prophylaxis and rMOM from birth until discharge. A positive HIV-PCR by 4–6 weeks of life was used to confirm maternal to infant HIV transmission.

Results: Of the 80 eligible infants admitted between 2010 and 2013, 63 (79%) were exposed to antenatal ART. Seventy-eight (97.5%) tested HIV-PCR negative at 4–6 weeks. Of the two infants who tested positive, both presented with features of an acute HIV infection. The absence of MTCT in the remaining 78 infants given ARV prophylaxis and rMOM suggests that rMOM is an unlikely source of infection in the two infected infants.

Conclusion: rMOM, in the presence of infant prophylaxis, was a safe feeding option for HIV-exposed VLBW infants. It should be strongly considered for these infants, as rMOM likely provides additional maternal and child benefits.


Keywords

HIV; Prevention of mother-to-child transmission; Mother-to-child transmission; Very low birth weight; Peripartum transmission; Mother’s own milk; Raw breast milk; Nevirapine

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