Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Reuters NewMedia - Tuesday August 24, 1999

A total of 47 out of 672 babies studied in the southeast African nation of Malawi contracted the AIDS virus from their mothers' breast milk over the two-year life of the study, with half the infections occurring within the first six months, researchers from Johns Hopkins University said.

"The HIV transmission risk due to breast-feeding was highest in the early months of life, but remained substantial for as long as an infant continued to breast-feed," study author Paolo Miotti wrote in the Journal of the American Medical Association.

"Early weaning has been proposed as one possible strategy to limit HIV transmission through breast milk," he said. But alternatives to breast milk are often scarce, unsafe or culturally unacceptable in Africa.

"Although discontinuing breast-feeding after six months would have prevented half of the HIV infections in our study, such an approach would increase the risk of illness and death from the respiratory and diarrheal diseases that antibodies and other factors in breast milk help protect against," Miotti added.

The study found that 21 of the 47 infections occurred within five months after birth, with another 15 babies infected between the ages of six and 11 months, seven infections between months 12 and 17, and four infections between 18 and 23 months.

AIDS-infected mothers in the United States and other developed nations are discouraged from breast-feeding and urged to use baby formula.

Another finding of the study was that younger mothers and mothers with fewer than four children ran a higher risk of transmitting the disease to their newborns.

The researchers speculated that the reason might be that women with less breast-feeding experience are more likely to develop an inflammation of the mammary tissue, called subclinical mastitis, a condition found to increase the level of HIV virus in infected mothers' breast milk.

Recent research has shown that a relatively short and inexpensive treatment with antiretroviral drugs such as nevirapine or AZT -- or zidovudine -- can sharply reduce the rate of virus transmission from a pregnant mother to her fetus. None of the women in the Malawi study conducted between 1994 and 1997 received antiretroviral drugs either before or after having their uninfected babies. No babies participating in the study became infected after breast-feeding stopped. AIDS-fighting drugs and infant formula are often beyond the reach of poor families in African countries where AIDS is rampant and breast-feeding nearly universal, the report said.

An editorial in the same journal by doctors from the Centers for Disease Control and Prevention outlined the dilemma in developing countries where "increases in HIV-related infant mortality reverse the hard-won gains in child survival related to immunization, oral rehydration, and breast-feeding programs."
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