This article originally appeared on NAM’s website.

An international group of researchers involved in the ANRS 12174 randomised controlled trial of pre-exposure prophylaxis (PrEP) for infants say that it is high time we started giving PrEP to all breastfed babies of HIV-positive mothers in countries where the likelihood of transmission via breastfeeding remains significant.

Dr Philippe van de Perre of the University of Montpellier in France and colleagues say that the rate of mother-to-child transmission, although it has fallen by over 50% since 2010, is still far too high in Africa. Infant HIV incidence in the children of HIV-positive mothers is 8.9% per year in the 21 countries in Africa most affected by HIV and has only been brought below 5% in five of them (Botswana, Namibia, Uganda, South Africa and Swaziland). The World Health Organization (WHO) has recommended offering PrEP to any population in which the expected annual incidence of HIV is over 3% and the writers say it violates the rights of infants to exclude them from this recommendation.

The WHO’s main strategy for preventing vertical (mother to baby) transmission of HIV is its “Option B+” strategy which recommends offering lifelong antiretroviral therapy (ART) to any woman with HIV who becomes pregnant or is diagnosed during pregnancy or breastfeeding. Option B+ also recommends six weeks of PrEP with the drug nevirapine for the newly born baby but breastfeeding usually continues well beyond this period. Of the 8.9% of babies in the 21 most-affected countries who acquire HIV through vertical transmission, 3.9% acquire HIV more than six weeks after birth, meaning that 44% of infections are occurring through breastfeeding after this point.

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