Breastfeeding as a way of HIV transmission to children

Objective. Identification of factors associated with the risk of HIV infection in children during breastfeeding (BF) in order to reduce the incidence of mother-to-child HIV transmission in the Russian Federation.

Materials and methods. The personalized data of form No. 266U-88 «Operational report on a person in whose blood antibodies to HIV were detected in the immunoblot reaction», cards of the contact tracing of HIV infection cases, data of the departmental monitoring form of Russian Federal Service for Supervision of Consumer Rights Protection and Human Well-Being «Information on measures to prevent HIV infection, hepatitis B and C, detection and treatment of HIV patients»and data of form №. 4 of the federal statistical monitoring «Information on the results of a blood test for antibodies to HIV» for the period 1987-2020 were analyzed.

Results. During the follow-up period, 692 children were infected with the disease by their mothers, and 2 children were infected by wet nurses. The number of annually registered cases gradually increased until 2018, when 101 children were infected during breastfeeding. Later, the number of such cases began to decrease simultaneously with a decrease in the number of newly registered cases of HIV infection, an increase in ART coverage of the HIV-positive population, and the start of HIV testing of sexual partners of pregnant women. The factors determining the infection of children included the continuation of breastfeeding with low adherence of mothers to ART (42.9%) or complete refusal of treatment (21.4%). 14.3% of women continued to breastfeed their child in order to hide their HIV infection from others. 14.3% of mothers were not followed-up in specialized institutions and breastfed. Infection during breastfeeding led to late diagnosis of HIV infection in the child. The median age of children when they were diagnosed with HIV during the follow-up period was 3.2 years. In 2016–2020. HIV infection was detected in 65% of children during the epidemiological investigation, in 18% - during examination for clinical indications. The reasons for examining the remaining children are unclear.

Conclusion. Prevention of HIV infection in children during breastfeeding remains a difficult task that requires improvement and expansion of the range of measures, including prevention of HIV infection in women; timely testing for HIV infection; increasing the coverage of HIV-positive women with continuous therapy, counseling in the pre- and postpartum period; increasing women’s adherence to treatment; provision of formulas replacing breast milk; stimulating examination of sexual partners of pregnant women; reducing the stigmatization of HIV-positive women.