Re: [pronut-hiv] Viral load cut-off point

["Rachel Stern" <sternworks@verizon.net>]

Hi, Martin.
 I don't believe there is a cut-off point for either viral load 
(upper limit) or T-cells (lower limit), and there is always some risk 
because of other factors that could enter in. (Another very important factor 
in transmission is maternal new infection or reinfection, because viral load 
gets very high following new infection. All nursing moms, whether 
HIV-infected or -noninfected, should be counseled about this.)

A couple of people on this thread have noted that antiretroviral therapy for 
the breastfeeding mom, which you'd expect to quickly suppress viral load, 
greatly reduces transmission. Mothers may receive this therapy regardless of 
their viral load or T-cell measures; I don't know what happens after 
weaning. Right now, this approach seems like the most promising resolution 
to the breastfeeding issue.

The article I mentioned earlier is "Kuhn, L et al. 
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0001363"; 
Transmission by HIV-positive moms that chose exclusive breastfeeding for 4 
months (standard is now 6 months) were compared to moms who mixed-fed. At 
end of 4 months, among 56 women who mixed-fed and whose T-cells were over 
350, there was no transmission.  Among a total of 364 moms with greater than 
350 T-cells, there were 5 infections; among 370 moms with less than 350 
T-cells, there were 31 infections. Some mothers began HAART during the 
study. If you read the study, I think you'll see that although exclusive 
breastfeeding vs mixed significantly reduced transmission, transmission 
rates even among exclusively breastfed infants were quite high - about 1% 
per month.

Of course, this is just one study, and others will have different results, 
but I don't believe any have a <4% infection rate unless moms are on HAART.


----- "martin kumbe" wrote:


Hi Stern,

Thanx for the insights on this exciting discussion. Just onne 
clarification...Is there a recommended viral load cut-off point(upper limit) 
at which the mother should be adviced to discontinue exclusive breast 
feeding to reduce chances of MTCT? Will appreciate if you could share the 
results of the large study you mentioned.

Martin Kumbe