HIV and infant feeding practices
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Date
1990
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS
Abstract
In industrialized countries HIV-1-seropositive mothers who are nursing infants are advised to use
artificial feeds, whilst HIV-infected women in the developing world are recommended to breastfeed.
Current evidence is insufficient even to estimate the attributable risk associated with breastfeeding.
There is a possibility that the policy promoted in industrialized societies will eventually
become established in urban and peri-urban areas of sub-Saharan Africa. This may be defensible
for some elite urban mothers providing safe artificial feeding. However, calculations of the
consequence of any population-level change to bottle-feeding indicate that it would result in
more deaths from infectious causes, substantially adding to the child deaths directly attributable
to HIV-1 infection. These data demonstrate that there is a clear need for policy-makers and
health care workers to undertake further promotion of breast-feeding despite the AIDS epidemic.
PIP: The 3 retrospective studies conducted to date have involved a total of 12 children exposed
to human immunodeficiency virus (HIV) via breastfeeding have yielded findings of 8 cases in
which breastfeeding did appear to have led to HIV transmission and 4 cases where the children
did not become infected. These findings, as well as the detection of HIV-1 in the breast milk of 3
women, have led to a policy in most developed countries that HIV-positive mothers are advised
to use artificial milk. Of concern, however, is the possibility that this policy may become adopted
in sub-Saharan African countries where child mortality from infectious diseases associated with
bottle-feeding greatly exceed the risks of HIV transmission through breastfeeding. Compared to
exclusively breastfed infants, artificial feeding in sub- Saharan countries is associated with a 1.8-
2.6 times greater risk of post perinatal mortality. To examine the impact of changes in infant
feeding practices in this regions, a model sub-Saharan country with an infant mortality rate of
90/1000 live births (ignoring the effects of HIV) was constructed and a 10% rate of maternal
HIV infection, a 30% vertical transmission rate of HIV, and a 20 % HIV-associated infant
mortality rate were assumed. To allow for competing causes of death, the number of infants
dying from HIV infection was reduced by 10%. Calculations suggest that a reduction from 90%
to 75% in the prevalence of breastfeeding would result in an increase in infant wastage of 1780
at best and 3580 at worst. The maximum (assuming a transmission rate of 100%) saving in infant
wastage if breastfeeding were entirely eliminated would be only 630. Although more research is
needed on the true level of risk from breastfeeding by HIV-infected mothers, it i s recommended
that breastfeeding should be continued in developing countries where artificial feeding does not
present a safe alternative, irrespective of the prevalence of HIV-1.
Description
Keywords
Breastfeeding, HIV-1-seropositive mothers, Sub-Saharan Africa
Citation
Nicoll, A., Killewo, J.Z. and Mgone, C., 1990. HIV and infant feeding practices: epidemiological implications for sub-Saharan African countries. AIDS (London, England), 4(7), pp.661-665.