c/o Children's Hospital and Health Center
3020 Children's Way, MC 5073
San Diego, CA 92123-4282
Phone: (858) 966-5981
Fax: (858) 541-4972
|
|
|
|
|
|
Breastfeeding and HIV: A Dilemma for the Developing World Yvonne E. Vaucher, M.D., M.P.H. Worldwide, more than 14 million women are living with HIV. Most are in Africa where, in some countries, more than 25% of all pregnant women screened are HIV positive. Very few African women have access to either HIV testing or antiretroviral therapy. In the year 2000, it was estimated that over 500,000 African infants became infected with HIV through vertical transmission from mother to child before, during or after delivery. Surveys in Africa show that approximately 15-30% of all infants born to HIV positive mothers are HIV positive shortly after delivery. An additional 15-20% acquire HIV as a result of breastfeeding. Overall, 30-50% of all infants born to HIV positive mothers without access to antiretroviral therapy are HIV positive at 6 months of age (De Cock, Fowler, & Mercier, 2000). Two recent studies suggest that the rate of HIV transmission via breastmilk is about 16%, resulting in approximately 40% of all infant HIV infections being attributable to breastfeeding (Coutsoudis, et al., Nduati, et al.). In industrialized countries such as the US, the rate of maternal to child HIV transmission has been dramatically reduced by a combination of prenatal screening, maternal and infant antiretroviral treatment, C-section delivery and formula feeding. Most of these interventions are unrealistic in developing countries due to |
|
lack of personnel, infrastructure and financial resources, problems exacerbated by the devastating social and economic impact of AIDS. Attention has therefore been focused on the most "low tech" solution-substituting formula feeding for breastfeeding.
But is formula feeding feasible either? First, universal HIV screening would still be necessary to assure that formula feeding be recommended only for infants at risk of acquiring HIV after birth. After all, 75-90% of infants born in Africa are not at risk for HIV at all because their mothers are HIV negative. Formula feeding in these infants would substantially increase infant mortality and undermine years of successful breastfeeding promotion. Second, even if HIV screening were available, formula feeding requires ready access to clean water, the economic resources to buy sufficient amount of formula, clean feeding equipment, and cultural acceptability, all of which are lacking in most African countries. Can breastfeeding be modified to simultaneously retain health benefits and reduce the risk of HIV transmission? Coutsoudis et. al. examined the effect of duration and exclusivity of breastfeeding on vertical HIV transmission in a prospective cohort study of South African infants. The lowest rate of HIV transmission by 15 months (19%) was in exclusively formula fed infants. However, infants exclusively |
|
