AIDSWEEKLY Plus; Monday, April 9, 2007
Staff Medical Writers

The promotion of breastfeeding has been ranked as the most cost-effective intervention for child survival, and could prevent 13–15% of child deaths in low-income countries. However, in some circumstances, breastfeeding can transmit HIV. Previous estimates that the risk of postnatal transmission is between 10% and 20%, do not distinguish between exclusive and mixed breastfeeding.

Hoosen Coovadia, Nigel Rollins (University of KwaZulu-Natal, South Africa), and colleagues did a non-randomised intervention cohort study to assess the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding. They found that exclusive breastfeeding carried significantly lower risk of HIV transmission than all types of mixed breastfeeding. Infants who received formula milk in addition to breastmilk, before or after 14 weeks, were nearly twice as likely to acquire HIV infection as infants who received breastmilk only, and the addition of solids increased the risk 11-fold. Furthermore, mortality by 3 months of age for replacement fed babies was more than double that of those who were exclusively breastfed.

The authors conclude: "The key policy finding of our study is the definite demonstration that early introduction of solid foods and animal milks increases HIV transmission risks compared with exclusive breastfeeding from birth. These data, together with evidence that exclusive breastfeeding can be supported in HIV-infected women [and uninfected women], warrant revision of the present UNICEF, WHO, and UNICEF infant feeding-guidelines that were revised in 2000".

In an accompanying Comment, Wendy Holmes (Macfarlane Burnet Institute for Medical Research and Public Health, Melbourne, Australia) and Felicity Savage (Centre for International Health and Development, London, UK) state: "The increased resources now available to prevent HIV infection in children should be invested in ways that also improve maternal and child health in general. But very little is earmarked for promotion of breastfeeding. 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 prevelance".

Keywords: HIV/AIDS, AIDS, Acquired Immunodeficiency Syndrome, Clinical Trial Research, HIV, Human Immunodeficiency Virus, Virology, University of KwaZulu-Natal.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Coovadia HM, Rollins NC, Bland RM, et al., Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study, Lancet. 2007 Mar 31;369(9567):1107-16.

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