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
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
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)
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