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NEW YORK, Mar 14 (Reuters Health) - Exclusive breastfeeding, not formula or a mix of breast and bottle feeding, may be the safest choice for the children of HIV-infected mothers living in the developing world, new research suggests.
Children who were breastfed exclusively for at least three months had the lowest risk of contracting HIV when compared with babies fed formula only or both formula and breast milk, Dr. Anna Coutsoudis of the University of Natal in South Africa found in a study published in the February 16th issue of the journal AIDS.
Coutsoudis and her colleagues compared the risk of mother-to-child HIV transmission in three groups of HIV-positive women: 157 who gave their babies formula and other foods and never breast-fed; 118 who breastfed exclusively for at least 3 months; and 276 who breast fed and used formula and other foods.
The women had chosen which infant feeding strategy to use after receiving counseling about the risks of transmitting HIV through breastfeeding and the health benefits of breastfeeding.
Up to 6 months, children of the women who never breast fed and those who breast fed exclusively had about the same risk of becoming HIV-positive. But the risk among babies fed on both breast milk and formula was actually higher. By 15 months, exclusive breast-feeders had the lowest risk of all three groups. The probability of HIV infection in exclusively breast-fed babies was about 25%, whereas the probability in those who received mixed feeding was about 36%.
The results appear to contradict current health policy on preventing mother-to-child transmission of HIV. Public health groups, including the World Health Organization and UNICEF, have recommended that women with HIV avoid or limit breastfeeding when alternative food sources for their infants are available.
On the other hand, WHO and UNICEF also recommend that HIV-negative women breastfeed their children exclusively for at least six months, because breastfeeding reduces a baby's risk of diarrhea, allergies and respiratory illness.
The researchers aren't sure how to explain the fact that mixed breast-and-bottle feeding posed the greatest risk in terms of transmission of HIV. They speculate that foods other than breastmilk may damage an infant's gastrointestinal tract, upping the chances of infection with the virus. Coutsoudis and her colleagues note that "a study in Guatemala of non-HIV-infected children showed that gut damage was greatest with mixed breastfeeding and least with exclusive breastfeeding."
More studies in other regions must be done to corroborate these findings, Coutsoudis and her colleagues conclude. "If these results are confirmed, then the public health benefits for HIV-infected women in developing countries is considerable."
The findings are promising, but need to be confirmed, Dr. Paolo Miotti, a pediatrician in the division of AIDS at the National Institute of Allergy and Infectious Diseases told Reuters Health.
And even if exclusive breastfeeding is found to be best, Miotti adds, this strategy would be difficult to implement in Africa, where mixed feeding is common. "Mothers tend to start with supplemental foods very early, in part because of tradition, in part because that brings supplemental calories to the baby," he notes.
The one thing that is clear, Miotti notes, is that mothers can pass HIV to their babies through their breast milk.
Source: AIDS 2001;15:379-387.
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