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Saturday, March 31st 2007

Postnatal HIV Transmission

Exclusive breastfeeding may be the best option for HIV+ women and their children in subsaharan Africa.

Doctors today call for UN guidelines to be changed following research showing that exclusive breastfeeding protects the babies of HIV positive women from becoming infected with the virus that causes Aids.

Guidelines from Unicef, the World Health Organisation and UNAIDS say the best option is to bottle-feed the babies with formula milk…Where exclusive bottle-feeding is not possible, mothers should exclusively breastfeed, they say.

Call me surprised. The worst of all worlds is ‘mixed’ feeding,

Research in the medical journal the Lancet today shows that is the worst of all worlds. Babies of mothers with HIV who receive a mixture of milk and solid foods are 11 times more likely to become infected than those who are exclusively breastfed. Those who are given formula milk as well as breast milk are nearly twice as likely to become HIV positive.


I’m Pretty Sure This Is What They Really Meant By “Mixed” Feeding

The authors try to explain why mixed feeding would show such results (Registration Required),

Exclusive breastfeeding ordinarily protects the integrity of the intestinal mucosa, which thereby presents a more effective barrier to HIV. Exclusive breastfeeding is also associated with fewer breast health problems than is mixed feeding, such as subclinical mastitis and breast abscesses, which in turn are associated with increased breastmilk viral load.

Why breastfeeding may be the best option revolves around increased non-HIV related mortality in those who were exclusively formula fed. According to the discussion published in The Lancet,

We noted that mortality in the first 3 months of life was roughly doubled in the group receiving replacement feeding compared with the exclusive breastfeeding group (15% vs 6%).

If these women [who were formula feeding] also had clinical symptoms [from their HIV infection], their ability to care for their children appropriately could have been affected. A significant increase in early mortality in formula fed versus breastfed infants was also identified in studies in Kenya (11% vs 9%) and Botswana (7·6% vs 3·7%).

Clearly there is a risk of HIV transmission from breast milk to an infant. Even with mothers with high CD4 counts and access to and compliance with their antiretrovirals. The Lancet publication reports,

14·1% of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19·5% by 6 months

A British Medical Journal news summary of a 1999 JAMA published study says,

During breast feeding, from the first month up until the end of months 5, 11, 17, and 23, the cumulative rate of infection was 3.5%, 7.0%, 8.9%, and 10.3%, respectively.

So the risk is there but apparently, weighed against the increased risk of HIV infection with mixed feeding and the increased risk of non-HIV related mortality with exclusive formula feeding the best option is to encourage HIV+ mothers to always breastfeed their children.

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