Great Ormond Street Hospital for Children NHS Foundation Trust.
UCL Great Ormond Street Institute of Child Health.
Curr Opin Infect Dis. 2024 Feb 1;37(1):8-16. doi: 10.1097/QCO.0000000000000986. Epub 2023 Oct 27.
HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART.
Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options.
Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
在妊娠期间进行 HIV 筛查、采用普遍的抗逆转录病毒治疗（ART）和避免母乳喂养，可以几乎完全预防 HIV 的垂直传播。母乳喂养与传播的额外风险相关，尽管在采用抑制性母体 ART 时，这种风险极低。必须平衡考虑母乳喂养对 HIV 感染者（PLHIV）妇女及其婴儿的益处与风险。高收入国家的指南已经发生了变化，逐渐转向支持接受抑制性 ART 的妇女进行母乳喂养。
在全球范围内，母乳传播在新的婴儿感染中所占比例越来越大。大多数传播数据来自于包括未接受抑制性 ART 的妇女的研究。在病毒载量不可检测的情况下，母乳传播很少发生，尽管风险因素仍不清楚。关于支持母乳喂养的结局数据正在不断积累，为指南提供了证据并为婴儿喂养决策提供了信息。用于母体暴露前预防或治疗以及婴儿产后预防的长效抗逆转录病毒药物是未来很有前景的选择。
接受抑制性 ART 的母乳喂养垂直传播的风险非常低，并且对 PLHIV 妇女及其婴儿有多种益处。然而，在放松母乳喂养指导时应谨慎，以免危及到到 2030 年消除垂直传播的全球目标。
