Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
Curr Opin HIV AIDS. 2013 Sep;8(5):467-73. doi: 10.1097/COH.0b013e3283632ba2.
In the past 5 years, research has identified antiretroviral drug interventions that significantly reduce HIV transmission through breastfeeding. This evidence is reflected in WHO guidelines that now recommend national health authorities to adopt a public health approach for HIV and infant feeding, namely to promote and support a single infant feeding practice to all HIV-infected mothers. In most developing countries where diarrhoea, pneumonia and malnutrition are common causes of infant mortality, this means breastfeeding and providing antiretroviral drugs. Scaling-up these approaches is essential to eliminate new paediatric infections and to improve maternal health. The review examined knowledge and implementation of these interventions, and considered areas for future research.
Most recent reports focus on approaches for resolving implementation challenges rather than investigating new clinical interventions. Wherever WHO guidelines have been implemented, significant reductions in HIV transmission and improved survival are reported. Health system inefficiencies and social barriers continue to impede progress. A limited number of studies examined mechanisms of transmission and how breastmilk and viral factors influence these processes.
The findings of recent research should give confidence to health workers and policy makers that major improvements in HIV-related child and maternal mortality are attainable and justify intensified efforts.
目的综述：在过去的 5 年中，研究已经确定了抗逆转录病毒药物干预措施，这些措施可以显著降低通过母乳喂养传播 HIV 的风险。世界卫生组织的指南反映了这一证据，该指南现在建议各国卫生当局采取针对 HIV 和婴儿喂养的公共卫生方法，即向所有感染 HIV 的母亲推广和支持单一的婴儿喂养方法。在大多数发展中国家，腹泻、肺炎和营养不良是婴儿死亡的常见原因，这意味着要进行母乳喂养并提供抗逆转录病毒药物。扩大这些方法至关重要，这不仅可以消除新的儿科感染，还可以改善母婴健康。本综述审查了这些干预措施的知识和实施情况，并考虑了未来研究的领域。
最新发现：最近的报告大多侧重于解决实施挑战的方法，而不是调查新的临床干预措施。只要实施了世界卫生组织的指南，就会报告 HIV 传播显著减少和生存率提高。卫生系统效率低下和社会障碍继续阻碍进展。少数研究探讨了传播机制，以及母乳和病毒因素如何影响这些过程。
总结：最近研究的结果应该让卫生工作者和决策者有信心，即可以实现与 HIV 相关的儿童和产妇死亡率的重大改善，并证明有理由加强努力。
