Exclusive Breastfeeding Prevents Mother-to-Child Transmission of HIV
April 3, 2007 by Amy Spangler | 3 questions or comments
Children with AIDS
Researchers at the Africa Centre for Health and Population Studies followed 1,372 infants born to HIV-infected mothers in South Africa. Among the 1,132 exclusively breastfed infants, the rates of HIV infection at 6 weeks and 6 months of age were 14.1% and 19.5%, respectively. Infants who received solid foods in addition to breastfeeding were 10.87 times more likely to become infected with HIV than infants breastfed exclusively. In addition, infants receiving a combination of human milk and artificial milk (formula) at 12 weeks of age were 1.82 times more likely to become infected with HIV than infants exclusively breastfed.
The 3-month mortality rate was 6.1% in exclusively breastfed infants and 15.1% in infants given replacement feeds. Predictors of HIV transmission included birth weight <2,500 grams and low maternal CD4+ cell count <200 cells/microliter.
Wendy Holmes, from the Macfarlane Burnet Institute for Medical Research and Public Health in Melbourne, and Felicity Savage, from the Center for International Health and Development in London, emphasize that “investment in promoting, protecting, and supporting exclusive breastfeeding to 6 months has the greatest potential to improve HIV-free child survival in settings with both high and low HIV prevalence.”
In 2005, 630,000-860,000 infants were infected with HIV. It is estimated that 280,000-360,000 infants acquired the infection through breastfeeding. In the developed world, the risk of mother-to-child transmission has been significantly reduced from about 25% to 2% with the use of antiretroviral medications. But these medications are not widely available in resource-poor countries.
According to lead researcher Hoosen Coovadia, “The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.”
Does this mean that we may at some point (or should) allow our HIV moms to breastfeed their newborns along with giving the usual anti-virals that are prescribed by our pediatricians?
As health professionals, our role in caring for pregnant women who are HIV positive is to provide accurate and timely information, so that each woman, in collaboration with her health care provider, can make an informed decision with regard to infant feeding.
It has long been suggested that for some HIV positive mothers and their infants, the benefits of breastfeeding may outweigh the risks of formula feeding. The research published in The Lancet adds to that body of evidence. However, at the present time, there has been no change in policy, and the most recent data is currently being reviewed.
The fact remains that breastfeeding is a vehicle for HIV transmission. So any infant feeding decision must carefully consider the benefits and the risks.
It is likely that any change in policy will affect women in developing countries as opposed to women in developed countries where alternatives to breastfeeding are readily available.
The most recent data suggests that there is still much to be learned about mother-to-child transmission of HIV.
According to a recent study published in Pediatrics, exclusive and prolonged breastfeeding also protects infants against diarrhea and respiratory infection.
Data from a population-based survey of 15,890 health, term infants in the UK show that the number of hospitalizations each month during the first 8 months of life for diarrhea and respiratory infection could be reduced by 53% and 27% respectively if babies were exclusively breastfed.
Given the current exclusive breastfeeding rate in the UK of 1.2% at 6 months, just think of the cost savings.
http://pediatrics.aappublications.org/cgi/reprint/119/4/e837