Preventing mother-to-child HIV transmission in the new millennium: the challenge of breast feeding
Preventing mother-to-child HIV transmission in the new millennium: the challenge of breast feeding
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DOI：
10.1111/j.1365-3016.2003.00528.x
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发表时间：
2004-01-01
影响因子：
2.8
通讯作者：
Susser, M
中科院分区：
文献类型：
--
作者：
Kuhn, L;Stein, Z;Susser, M
短期抗逆转录病毒药物大大增加了减少艾滋病毒母婴传播的前景。然而，母乳喂养传播给这一看似简单的干预带来了希望。我们回顾了数学模型，以评估母乳喂养与配方奶喂养相关的竞争风险。这些都表明，在艾滋病毒流行占主导地位的欠发达世界，这两种选择都没有经过修改，为艾滋病毒阳性妇女提供了合理的选择。在婴儿死亡率高于每1000名活产儿中约40人的情况下，如果只向感染艾滋病毒的妇女提供配方奶粉，使用配方奶粉将导致的额外死亡人数将大致等于或高于可预防的艾滋病毒感染人数。只有在婴儿死亡率低于千分之四十的情况下，母乳的风险才会更大。因此，在所有情况下都没有充分的理由完全避免母乳喂养。研究开发和测试更安全的婴儿喂养替代品是当务之急。一方面，需要充分测试在保持母乳喂养的同时减少艾滋病毒传播的方法，就像纯母乳喂养可以做到的那样。另一方面，减少与配方奶喂养相关的非艾滋病毒发病率和死亡率的方法，如教育或卫生干预措施可以做到的那样，同样需要测试。无论采用哪种方法，实施预防母婴传播艾滋病毒的所有核心内容的必要基础是为母亲提供称职的咨询。需要采取创新的方法，动员和培训卫生保健工作者中的有效辅导员，并酌情调动和培训社区成员。
Short courses of antiretroviral drugs have greatly enhanced the prospect of reducing mother-to-child HIV transmission. Yet transmission by breast feeding clouds hopes for this seemingly simple intervention. We revisit mathematical models to assess the competing risks associated with feeding by breast vs. formula. These indicate that, in the less developed world where the HIV epidemic predominates, neither option, unmodified, offers a reasonable choice for HIV-positive women. Where infant mortality rates are greater than about 40 per 1000 live births, if formula were made available to HIV-infected women only, the excess number of deaths that would result from formula use would be approximately the same or greater than the number of HIV infections that might be prevented. Only at lower infant mortality rates, less than about 40 per 1000, is the risk greater on the breast.There are thus no good grounds for the total avoidance of breast feeding under all conditions. Research to develop and test safer infant feeding alternatives is an urgent priority. On the one hand, ways to reduce HIV transmission while preserving breast feeding, as exclusive breast feeding could do, need to be fully tested. On the other hand, ways to reduce non-HIV morbidity and mortality associated with formula feeding, as educational or sanitary interventions could do, equally need testing. With either approach, a necessary foundation for implementing all the core components of preventing mother-to-child HIV transmission is competent counselling for mothers. Innovative approaches are needed to mobilise and train effective counsellors among health care workers and, as appropriate, community members.