Breast Still Best If Mom Has HIV

William Mapham, a doctor and communications director at the Reproductive Health and HIV Research Unit, says that providing ARV treatment throughout pregnancy and afterwards, instead of just short courses of AZT, would save lives. He says pregnant women needed to be properly assessed, follow a full course of treatment, including AZT and have a low viral load.

Mapham says research and trials had proved breast-feeding was possible and better for the baby as breast-milk was healthier and cheaper than formula. As further research and trials were conducted on the epidemic, new information had emerged.

For many years, HIV-positive women were advised not to breast-feed for fear of passing on the virus to their babies.

About 420 000 children throughout the world were newly infected with HIV last year, the vast majority of them through mother-to- child transmission.

Global access to intervention to prevent HIV infections in infants was a major concern at the United Nations General Assembly Special Session on HIV-Aids a few years ago. Member states committed themselves to the goal of reducing the proportion of infants infected with HIV to 20percent by 2005 and 50percent by 2010.

Mapham and his colleagues argue that it would be less expensive to provide full treatment for women than care for HIV-positive babies in state hospitals, the cost of which varies from R700 to R3000 a month.

Health experts estimate the total amount needed to curb the spread of the virus to infants at R250-million, compared with the escalating cost of maintaining HIV-positive children.

"Further, a Caesarean section performed on one woman costs about R20000. It would be unnecessary in most cases to perform Caesareans as it would be safer to have a normal birth if a patient had been on ARVs," says Mapham.

Glenda Gray, a co-founder and co- director of the Perinatal HIV Research Unit at the Chris Hani Baragwanath hospital, who pioneered the AZT project that helps prevent the transmission of HIV from mother-to-child during pregnancy or childbirth, believes breast-feeding doubles the risk of a baby becoming infected. But Mapham says this is only the case when the mother has not been on ARVs and her viral load is high.

Transmission is believed to occur more commonly towards the end of pregnancy and during labour.

Mapham and colleagues believe those infected with the virus are less likely to develop Aids-related illnesses and live longer if treatment starts before the CD4 count is at 200 or less. The unit hopes the health department will consider its recommendation of starting treatment at a CD4 count of 350.

We have come a long way from the days when the government terminated the funding of the anti-Aids drug AZT. A pilot project that would have given AZT to 200 pregnant women infected with HIV would have saved millions of rands and many lives. Aids advocacy group Treatment Action Campaign eventually won a lawsuit against the government which forced the provision of AZT.

Today, thousands of HIV-positive women come to the RHRU clinic in Hillbrow, Johannesburg, for free ARV treatment. The clinic is the largest community-based HIV treatment centre in the world, with more than 6000 patients. The percentage of women infected is between 28 and 30 percent.