Can mothers living with HIV exclusively breastfeed?

• Newly discovered component could lead to more effective drugs

The World Health Organisation (WHO) in this special publication addresses some of the questions raised by mothers especially those living with Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) on the virus and infant feeding.

Also, scientists from the Medical Research Council Laboratory of Molecular Biology in Cambridge and University College London – both in the United Kingdom – have uncovered key components of HIV, which they believe could lead to new approaches for drugs to fight the infection.

1. Can mothers living with HIV breastfeed their children in the same way as mothers without HIV?
WHO recommends that all mothers living with HIV should receive life-long antiretroviral therapy (ART) to support their health and to ensure the wellbeing of their infants.

WHO released guidelines in July 2016 advising that, in countries that have opted to promote and support breastfeeding together with ART, mothers living with HIV who are on ART and adherent to therapy should breastfeed exclusively for the first 6 months, and then add complementary feeding until 12 months of age. Breastfeeding with complementary feeding may continue until 24 months of age or beyond.

Previously, WHO advice was to breastfeed for 12 months but then stop breastfeeding if a nutritionally adequate and safe diet could be provided.

The new guidance is based on scientific evidence that shows ART is very effective at preventing HIV transmission through breastfeeding as long as the mother is adherent to therapy. The new evidence means that mothers living with HIV and their children can benefit from the many advantages of breastfeeding – such as improved growth and development – in the same way as mothers who do not have HIV and their children. WHO recommendations emphasise the need for health systems to therefore achieve quality HIV services that reliably provide ART and continue to care for mothers living with HIV.

2. Is mixed feeding better than no breastfeeding at all, if the mother is on HIV treatment?
Yes. Mothers living with HIV can be reassured that ART reduces the risk of post-natal HIV transmission even when the baby is on mixed feeding. Although exclusive breastfeeding is recommended for the first 6 months, mixed feeding is better than no breastfeeding. Encouraging mothers living with HIV to breastfeed exclusively is still strongly advised because it benefits the infant in many ways including, reduced illness, and improved growth and development.

3. If a mother on HIV treatment plans to return to work or school, is a shorter duration of breastfeeding better than no breastfeeding at all?
Yes. Mothers and health-care workers can be reassured that shorter durations of breastfeeding of less than 12 months are better than never initiating breastfeeding.

4. What can be done to support breastfeeding among mothers living with HIV?
Governments and local authorities should actively promote and implement services to create a supportive environment for mothers living with HIV to remain adherent to treatment and to breastfeed their infants in all settings: at work, at community centres, in health clinics, and in their homes.

Meanwhile, HIV weakens a person’s immune system by destroying important cells that fight disease and infection. Only certain body fluids – blood, semen, rectal fluids, vaginal fluids, and breast milk – from a person who has HIV can transmit HIV.

Although there is no cure for HIV infection, improved treatments allow people living with HIV to slow the virus’ progression and stay relatively healthy for several years.

HIV is a part of a subtype of viruses called retroviruses, which means that the virus is composed of Ribo Nucleic Acid (RNA) – instead of normal Deoxy ribonucleic Acid (DNA) – and has the unique property of transcribing RNA into DNA after entering a cell.

This retroviral DNA can then integrate into the DNA of the host cell and remain undetected by the immune system. The infected cell can produce virus cells with different RNA genomes, which restarts the infection cycle. This unusual method of infection and replication has made it difficult to develop a vaccine for HIV.Iris-like pores discovered in HIV

Previously, it was unknown exactly how the virus gets the genetic building blocks it needs to synthesize the DNA to infect the host cell. However, the research team has made new discoveries into this mechanism.A protein shell known as the capsid surrounds the virus. The researchers found that the capsid contains iris-like pores that open and close like an eye.

The pores can open and close very quickly, enabling them to “suck in” the genetic building blocks called nucleotides that the virus needs to build the DNA to infect the cell, while keeping out any unwanted molecules. This helps to explain why HIV is so successful at evading the immune system.

The discovery, published in the journal Nature, was made by examining the atomic structure of the capsid and creating mutant HIV viruses, which allowed the team to see the behavior of the pores.

Dr. Leo James, of the Medical Research Council (MRC) Laboratory of Molecular Biology, says: “We used to think that the capsid came apart as soon as the virus entered a cell but now realize that the capsid protects the virus from our innate immune system. The channels we’ve discovered explain how the fuel for replication gets into the capsid to allow the viral genome to be made.”
Inhibitor molecule designed to block pores

To prevent the virus from copying itself and infecting more cells, the scientists developed an inhibitor molecule – hexacarboxybenzene – that can block the capsid pores. The molecule successfully blocks the pores, ensuring that the virus can no longer replicate itself, rendering it noninfectious.

The hexacarboxybenzene molecule is unable to enter human cells, and, therefore, cannot help with any cells that have already been infected with HIV.

However, the researchers indicate the findings could lead to both future drugs that can enter human cells and block the pores from within and greater effectiveness of existing treatments, by altering them to penetrate pores.Additionally, this new prototype molecule could assist in the development of drugs to treat other retroviruses.