Maternal, newborn, child and adolescent health

Care of the HIV-exposed or infected newborn

An estimated 430 000 children were newly infected with HIV in 2008, over 90% of them through mother-to-child transmission (MTCT). Prevention of mother-to-child transmission (PMTCT) of HIV has been at the forefront of global HIV prevention efforts since 1998, following the success of the short-course zidovudine and single-dose nevirapine clinical trials in reducing transmission.

These trials offered the promise of a relatively simple, low-cost intervention that could substantially reduce the risk of HIV transmission from mother to baby. Research and programme experience over the past ten years has demonstrated newer and more effective ways to prevent new paediatric HIV infections, particularly in high-burden, low-resource settings.

Breastfeeding is the best way to feed an infant. Breastfeeding, and especially early and exclusive breastfeeding, is one of the most valuable interventions for improving child survival. Breastfeeding also confers many benefits in addition to reducing the risk of child mortality. A woman infected with HIV, however, can transmit the virus to her child during pregnancy, labour or delivery, or through breastfeeding.

The dilemma has been to balance the risk of infants acquiring HIV infection through breastfeeding with the increased risk of death from causes other than HIV, in particular malnutrition and serious illnesses such as diarrhoea and pneumonia, due to not breastfeeding.

A large body of evidence on HIV and infant feeding has accumulated in recent years which shows that giving antiretroviral drugs (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. In view of this evidence, WHO released new 'Guidelines on HIV and infant feeding' in 2010.

The guidelines contain revised principles and recommendations for infant feeding in the context of HIV and a summary of evidence that resulted in formulating the new guidelines. At the same time, new recommendations were released on antiretroviral therapy for prevention of mother-to-child transmission of HIV.