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Rapid Responses: Rapid Responses published:
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Infant feeding and HIV
- Sameer Chadha, Shikha Mehta, Medical Student , Maulana Azad Medical College, New Delhi ,India (12 March 2007)
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Infant feeding and HIV
- Dr Dieudonne Birahinduka,PhD (Moscow), MPH (Master in Public Health) Glasgow (18 March 2007)
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Infant breastfeeding and HIV/AIDS-WHO Recomendation -2007
- Professor Pranab Kumar Bhattacharya, Ray Anirban Medical officer HIV /AIDs Clinic, IPGMER KOlkata-20 (4 April 2007)
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Sameer Chadha, Medical Student Maulana Azad Medical College, New Delhi, India, Shikha Mehta, Medical Student , Maulana Azad Medical College, New Delhi ,India
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There is no doubt that Breast Feeding is the most ideal form of infant feeding and is crucial for lifelong health and well being of the infant. It provides unique nutritional, immunological, psychological and child spacing benefits while Artificial feeding exposes the infant to infections and results in over a million deaths annualy worldwide. The only true contraindication to breast feeding is when the mother is on anticancer drugs while galactosemia and phenylketonuria are contraindications to any milk feeding (except for specially designed formulae). Artificial feeding may be offered to an infant of HIV positive mother only if it is feasible, acceptable, affordable , sustainable and safe. These criteria are difficult to fulfill in the developing countries and the final decision should be left to the mother after explaining the risks and consequences involved. Competing interests: None declared |
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Dr Dieudonne Birahinduka,PhD (Moscow), MPH (Master in Public Health) Glasgow, Senior Clinical Fellow in Paediatrics Department of Paeditrics, Newham University Hospital, London E13 8RS
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Breast milk is a unique nutrient, provides antibodies and contains living immune cells. It leads to optimal brain development nurturing and close emotional attachment. Breastfeeding is a joyful, relaxing experience and a mode of contraception to the mother. It is however proven that breastfeeding is a risk factor to mother-to-baby transmission of the HIV virus although researchers showed that “infants exclusively breastfed for 3 months or more had no excess risk of HIV infection over 6 months than those never breastfed”.[ Coutsoudis et al, AIDS 15(3), 2001] HIV transmission through breastfeeding is not a major issue in the developed world where there is an easy access to safe, clean water and where milk substitutes are affordable. In the developing world the health risks of not breastfeeding are heavier that those of breastfeeding in cases of maternal HIV positivity. This is due to the high mortality rate from diarrhoeal diseases as a consequence of lack of water sanity, reduced resistance to gastrointestinal infections in formula fed babies and lack of enough resources for milk substitute’s supply. The dilemma to breastfeed or not in developing countries should be dealt with on an individual basis considering the financial circumstances of HIV parents, their level of understanding of the risks to HIV transmission through breast milk and their role in the prevention of gastrointestinal infections. This together with currently available research data should inform local public health policy and expert advice to would-be HIV infected parents. Competing interests: None declared |
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Professor Pranab Kumar Bhattacharya, Professor of Pathology, Incharge of Histopathology;cytogenetics, Blood Bank &VCTC, Institute of Post Graduate Medical Education& Research;244A AJC Bose Road, KOlkatta-20, W.B, India, Ray Anirban Medical officer HIV /AIDs Clinic, IPGMER KOlkata-20
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The risk of illness and death amongst infants who are not breastfed has long been known. New evidence and experience now confirms that artificial feeding also presents serious risks for HIV infected infants & mothers. There is convincing evidence that exclusive breastfeeding can be achieved with good quality councelling and support and consistant messages from all sources of public health information. A consensus statement on HIV and infant feeding was recently adopted by all relevant UN departments and agencies(1), following a technical consultation in Geneva, Switzerland, in October 2006, organized by WHO department of child and adolescent health and development (CAH) on behalf of Interagency task team (IATT) on prevention of HIV infections in pregnant women, mothers and their infants. The Consensus statement includes the following key recomendations-: * The most appropriate infant feeding option for an HIV infected mother should continue to depend on her individual circumstances, choice including her health status and the local situation, but should take greater consideration of the health services available locally and the counselling and support she is likely to recieve ** Exclusive breastfeeding is recomended for HIV infected women for the first six(6) months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time *** When replacement feeding is acceptable, feasable, affordable, sustainable and safe, avoidance of all breast feeding by HIV infected women is recomended The recomendations were agreed on the basis of the latest evidence on HIV and infant feeding including the following * Exclusive breastfeeding for up to six months was associated with three to four fold decreases risk of transmission of HIV compared to non-exclusive breastfeeding in three large cohort studies conducted in Cote d'Ivoire, South Africa and Zimbabwe ** There are indications that HAART for treatment eligible women may reduce postnatal HIV transmission, based on Programme data from Botswana, Mozambique and Uganda; follow up trial data on the safety and efficacy of this approach and on infant prophylaxis trials are awaited *** In settings where antiretroviral prophylaxis and free infant formula were provided, the combined risk of HIV infection and death by 18 months of age was similar in infants who were replacement fed from birth and infants breastfed for three to six months **** Breast feeding of HIV infected infants beyond six months was associated with improved survival compared to stopping breastfeeding So an HIV infected women chooses to breastfeed, exclusive breastfeeding for the first six months can be recommended. This recommendation is the same for HIV negative women and women who do not know their HIV status. However, breast feeding by HIV infected mothers is not without risk for the infant. But the risk of HIV infection must be balanced with risks associated with artificial feeding and this must be done for each HIV infected women on an individual basis. References CAH, five other wHO departments(NHD Acknowledgement: Authors acknowledge discussion with Mr. Rupak
Bhattacharya MSC and Mrs Dahlia Mukherjee BA(Hons) cal.on this issue.
Competing interests:
The first author is in charge of VCTC Center of IPGMER
SSKM Hospital, Kolkata also |
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