Analysis

Pre-exposure prophylaxis for infants exposed to HIV through breast feeding

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1053 (Published 09 March 2017) Cite this as: BMJ 2017;356:j1053
  1. Philippe Van de Perre, professor1 2,
  2. Chipepo Kankasa, doctor3,
  3. Nicolas Nagot, professor1 2,
  4. Nicolas Meda, professor45,
  5. James K Tumwine, professor6,
  6. Anna Coutsoudis, professor7,
  7. Thorkild Tylleskär, professor8,
  8. Hoosen Coovadia, professor9
  1. 1Pathogenesis and Control of Chronic Infections, UMR 1058 INSERM, University of Montpellier, France
  2. 2CHU Montpellier, Montpellier, France
  3. 3Department of Paediatrics and Child Health, University Teaching Hospital, Lusaka, Zambia
  4. 4Centre Muraz, Bobo-Dioulasso, Burkina Faso
  5. 5Centre of International Research for Health, Faculty of Health Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso
  6. 6Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
  7. 7Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
  8. 8Centre for International Health, University of Bergen, Bergen, Norway
  9. 9Match Health Systems, School of Public Health, University of the Witwatersrand, South Africa.
  1. Correspondence to: P Van de Perre p-van_de_perre{at}chu-montpellier.fr
  • Accepted 10 February 2017

Philippe Van de Perre and colleagues say current strategies for preventing transmission of HIV infection from mother to child are inadequate and call for infants to be given pre-exposure prophylaxis

The AIDS 2016 conference, held in July in Durban, South Africa, lauded pre-exposure prophylaxis (PrEP) as the way forward for substantially reducing the rate of new HIV infections worldwide. PrEP is defined as the continuous or intermittent use of an antiretroviral drug or drug combination to prevent HIV infection in people exposed to the virus. The underlying pathophysiological rationale is that impregnating uninfected cells and tissues with an antiviral drug could prevent infection by both cell-free and cell-associated HIV (cell-to-cell transfer). PrEP’s tolerance and efficacy have been demonstrated in well designed clinical trials in men who have sex with men (MSM).12 In the Ipergay trial, 86% of HIV infections were averted in highly exposed men.2 PrEP has also been evaluated in other highly exposed groups such as transgender women, injecting drug users, serodiscordant heterosexual couples, and commercial sex workers.3

HIV exposed children: lost in translation

Uninfected pregnant or breastfeeding women in high incidence areas have also been suggested as a potential target population for PrEP, but infants exposed to HIV through breast feeding have not been mentioned.4 Numerous public declarations and petitions have produced a strong advocacy for extension of the PrEP principle to all high risk populations exposed to HIV, considering access to PrEP as part of human rights. Recently, the World Health Organization recommended offering PrEP to any population in which the expected incidence of HIV infection is above 3 per 100 person-years.35 So why are breastfed infants born to HIV infected women, a population that often has an overall HIV acquisition rate above 3/100 person-years, not receiving this clearly beneficial preventive health measure?

Current strategy not good enough

Since June 2013, …

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