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AFRO-NETS> Exclusive breast is best for HIV (+) women

Exclusive breast is best for HIV (+) women

Breast feeding safer than mixed feeding for babies of HIV mothers 

Jacqui Wise, London

Among babies of mothers infected with HIV, those exclusively breast 
fed for three months or more have no excess risk of HIV infection 
over six months than those who have never been breast fed, according 
to latest research. The results could have important implications for 
public health policy in developing countries, where the total avoid-
ance of breast feeding is not a realistic option for the vast major-
ity of women. 

Anna Coutsoudis from the department of paediatrics and child health 
at the University of Natal, South Africa, carried out a prospective 
cohort study involving 551 pregnant women infected with HIV who chose 
whether to breast feed exclusively, use formula feed exclusively, or 
carry out mixed feeding after being counselled (AIDS 2001;15:379-87).

In 1999 Dr Coutsoudis published the early results of the study in the 
Lancet (1999;354: 471-6). The infants have now been followed up for 
15 months, and the results confirm that infants exclusively breast 
fed had no excess risk of maternal transmission of HIV over six 
months when compared with infants who were not breast fed at all. 
Those at greatest risk were the infants fed on a mixture of breast 
milk and other foods and liquids.

Dr Coutsoudis concluded: "If these results are confirmed, then the 
public health benefits for HIV infected women in developing countries 
is considerable."

The study is the first to separate women who exclusively breast feed 
from those who carry out mixed feeding. The mechanism through which 
exclusive breast feeding may be safer than mixed feeding is not 
known. Dr Coutsoudis said: "We favour the hypothesis that contami-
nated fluids and foods introduced in [babies who received mixed feed-
ing] damage the bowel and facilitate entry into the tissues of HIV in 
breast milk."

Patti Rundall, policy director of the pressure group Baby Milk Ac-
tion, believes the new study has important implications. Bottle feed-
ing was not a realistic policy for many women because of the costs 
and lack of clean water.

"It is estimated that 1.7 million babies have been passed the HIV vi-
rus through breast milk, but this has to be compared with the 1.5 
million babies who die every year because they are not breast fed."

Dr Felicity Savage, of the Department of Child and Adolescent Health 
and Development at the World Health Organization (WHO), said: "The 
study... is not good enough to enable the WHO to recommend that HIV 
positive women breast feed exclusively as first choice."

BMJ 2001;322:511 (3 March 2001)

Claudio Schuftan

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