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February 27, 2007
Breastfeeding Safer for Some HIV+ Mothers (Reuters Health)
by Deena Beasley
Breast-feeding, which helps build a baby's immune system, may be the best option for HIV-infected mothers in developing countries, despite the risk of transmitting the virus that causes AIDS to their babies, according to new studies presented on Monday.
HIV-positive mothers generally are counseled to feed their babies formula to limit the risk of transmission of the human immunodeficiency virus, but that has caused problems in nations where clean water and other needs may not be met.
Dr. Hoosen Coovadia a pediatrician at South Africa's University of KwaZulu-Natal, told the 14th Conference on Retroviruses and Opportunistic Infections that instructing HIV-infected mothers in developing nations to breast-feed would result in about 300,000 children becoming infected with HIV, but would save 1.5 million from dying of other diseases.
"Breast milk is a cornucopia of immune factors," he said. "Breast-feeding should still be promoted, protected and preserved despite the risk of HIV."
Coovadia suggested that HIV-positive women in countries with an infant mortality rate of 25 percent or higher be urged to breast-feed.
Women with HIV infection are at risk of passing the virus to their infants during pregnancy, birth or breast-feeding. Without intervention, 20 to 45 percent of babies would contract the virus that causes AIDS from their mother, according to the World Health Organization.
"It is a dilemma for HIV-positive women," said Peggy Henderson, a scientist at the World Health Organization's department of child and adolescent health, citing studies showing a six-fold relative risk of death from infectious diseases in babies fed formula compared to those exclusively breast-fed.
In industrialized countries, including the United States, that rate has been cut to less than 2 percent by drug treatment, birth by Caesarean section and other methods.
Coovadia's 4-year study out of Durban, South Africa, found that 4 percent of babies who were exclusively breast-fed contracted HIV.
"By all means, if you have the resources to prepare hygienic milk -- clean water, access to electricity and so on -- that's for formula. If you don't have that, then the need is for exclusive breast-feeding," Coovadia said.
A study out of Botswana, which Coovadia called "the most stable, democratic country in Africa," found that most of the more than 500 children who died during a 2006 flood-related outbreak of diarrhea were being fed formula.
The "very surprising" findings show that in some settings the risk of dying from other infectious disease offsets the risk from HIV, said co-author Dr. Grace Aldrovandi, an associate professor at Children's Hospital Los Angeles.
A trial of 958 women in Zambia found that babies who become infected with AIDS also did better and were less likely to die when they continued to breast-feed.
The WHO recommended in October that HIV-infected mothers exclusively breast-feed for the first six months unless substitute milk is acceptable, feasible, affordable, sustainable and safe for them and their infants.
