Pathogenesis and Control of Chronic and Emerging Infections, INSERM, University of Montpellier, Etablissement Français du Sang, Antilles University, CHU Montpellier, Montpellier, France.
South African Medical Research Council, Cape Town, South Africa; Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa.
Lancet. 2021 Apr 3;397(10281):1316-1324. doi: 10.1016/S0140-6736(21)00570-5.
The rate of mother-to-child transmission (MTCT) of HIV from breastfeeding is increasing relative to other causes of MTCT. Early effective preconception and antenatal antiretroviral therapy (ART) reduces intrauterine and intrapartum MTCT, whereas maternal post-partum HIV acquisition, untreated maternal HIV, and suboptimal postnatal maternal ART adherence increase the risk of MTCT through breastfeeding. Although the absolute number of cases of MTCT acquired through breastfeeding is decreasing, the rate of decrease is less than the decrease in intrauterine and intrapartum MTCT. Unless current strategies are universally applied, they might not be sufficient to eliminate MTCT due to breastfeeding. Urgent action is needed to evaluate and implement additional preventive biomedical strategies in high HIV prevalence and incidence settings to eliminate MTCT from breastfeeding. Preventive strategies include: pre-exposure prophylaxis in breastfeeding women who have an increased risk of acquiring HIV; postnatal reinforcement strategies, such as maternal retesting for HIV, maternal care reinforcement, and prophylaxis in infants exposed to HIV via breastmilk; and active (vaccine) or passive immunoprophylaxis with long-acting broadly neutralising antibodies.
HIV 通过母乳喂养传播（MTCT）的母婴传播率（MTCT）相对于其他 MTCT 原因呈上升趋势。早期有效的孕前和产前抗逆转录病毒治疗（ART）可降低宫内和分娩时 MTCT，而产后母亲 HIV 获得、未治疗的母亲 HIV 和产后母亲 ART 依从性不佳则会增加通过母乳喂养 MTCT 的风险。尽管通过母乳喂养获得 MTCT 的绝对病例数正在减少，但下降速度低于宫内和分娩时 MTCT。除非普遍应用当前的策略，否则可能不足以消除因母乳喂养而导致的 MTCT。需要采取紧急行动，在 HIV 高流行和高发地区评估和实施额外的预防生物医学策略，以消除母乳喂养中的 MTCT。预防策略包括：有 HIV 感染风险增加的哺乳期妇女的暴露前预防；产后强化策略，如对 HIV 进行母婴复查、加强母婴护理和对通过母乳感染 HIV 的婴儿进行预防；以及使用长效广泛中和抗体的主动（疫苗）或被动免疫预防。
