AIDS Researchers Encounter Dilemma on Preventing HIV Transmission to Breastfed Babies

The word "dilemma" is actually quite an understatement in this case. Only two months ago I posted about reducing the risk of HIV transmission during breastfeeding by extending drug regimens. We learned that one dose of nevirapine can prevent mother-to-child transmission. However, a single dose apparently does not always work and the drug can be dangerous with some babies developing liver failure, rashes or low white blood cell counts. In addition, resistance to nevirapine may develop.

Last week,The Lancet described new research in which 2,000 breastfed babies in Ethiopia, Uganda, and India were given six weeks of nevirapine. Unfortunately, the research showed that the regimen was not protective. In fact, an editorial in the journal labeled the results "head scratchers." The main researchers in the study believe even more of the drug should be given, yet some of the Indian investigators are arguing that this move is too risky and that formula should be given instead. So the dilemma deepens. What is the bigger risk? Breastfeeding with a risk of transmission of the disease or formula-feeding in unsanitary conditions with a higher risk of mortality? Let's talk about this in my forum.