Mother-To-Child HIV Transmission
Providing infant formula to HIV-positive mothers might "cost atleast as many lives as it has saved" because the nutrition andantibodies supplied by breastmilk are "so crucial to young childrenthat they outweigh the small risk of transmitting HIV," the Washington Post reports. According to the Post, CDCresearchers have found that a decade-long, global initiative to provideinfant formula to HIV-positive mothers has "backfired" in Botswana bycausing infants to be more susceptible to other, more immediate deadlydiseases. The findings join a "growing body of research" on thepotential detriment of providing HIV-positive mothers with infantformula, the Post reports (Timberg, Washington Post, 7/23).
A study published in the March 31 edition of the journal Lancetfound that HIV-positive women in developing countries could reduce therisk of transmitting the virus to their infants if they exclusivelybreast-feed rather than supplement breastmilk with formula, animal milkor solid food. The study, led by Hoosen Coovadia and Nigel Rollins ofthe Africa Centre for Health and Population Studiesat the University of KwaZulu-Natal, found that infants who receivedmilk and solid food were 11 times more likely to become HIV-positivethan infants who were exclusively breast-fed. In addition, infants whoreceived both formula and breastmilk were twice as likely to becomeHIV-positive as exclusively breast-fed infants. About 6.1% of theexclusively breast-fed infants died by age three months, compared with15.1% of the infants who received other food sources. According to theresearchers, breastmilk might reinforce and protect the mucus membranelining of the intestines, serving as a barrier to HIV.
Rollinssaid that if women in developing countries exclusively breast-feed,about 50,000 to 100,000 infant deaths would be prevented annually. Somephysicians in response to the study called on the United Nations tochange its guidelines on breast-feeding for HIV-positive women indeveloping countries (Kaiser Daily HIV/AIDS Report, 4/2).
Botswana Study
Botswana -- which has an "extensive public water system, good roads and a legacy of competent governance" -- in 1997 joined a UNICEF-ledeffort to encourage HIV-positive women to use formula whenever suppliescould be provided safely and reliably, according to the Post.The country agreed to pay for the formula program as a service for newmothers. However, government clinics "often ran out of cans of formula,forcing parents and grandparents to buy cow's milk and feed theirchildren with diluted porridge or even flour and water," the Post reports.
TheCDC researchers, who presented their findings at a conference in LosAngeles in July, were investigating an outbreak of diarrhea duringBotswana's rainy season in early 2006. At least 532 children -- 20times the usual number of deaths from diarrhea -- died during theoutbreak. Only a few of the infants' mothers were breast-feeding.According to the researchers, tests conducted among government waterpipes in 26 villages in northeastern Botswana found contamination ineach one. In addition, tests of the ill infants' feces also found"dangerous" waterborne pathogens and a virulent form of E. coli, the Post reports.
Theresearchers found that it primarily was the infants who were notbreast-fed who were getting sick from the contaminated water. Among agroup of infants at one hospital, those admitted for diarrhea were 50times more likely to be taking formula or cow's milk compared withthose admitted for other illnesses. In addition, the researchers foundthat in one village, 30% of the infants who received formula had died,while none of those being breast-fed had.
The report reflects the "shifting scientific consensus" on breast-feeding, the Postreports. Since Botswana started its formula program, more and morestudies have shown that the risk of mother-to-child HIV transmissionprimarily comes from the combination of breastmilk and other foods,including formula and solids, that can damage the lining of an infant'sintestines. In addition, putting an HIV-positive woman on a combinationof antiretroviral drugs can reduce the risk of transmission throughbreast-feeding to less than 2%, according to Coovadia.
UNICEFafter providing training and technical assistance to the formulaprogram in Botswana began phasing out its infant-feeding programs in2002. Health officials in Botswana remain "unconvinced" that theformula program is not effective, the Post reports.Health Minister Sheila Tlou said that the 2006 outbreak was a one-timeoccurrence that should not dictate a policy. Officials now are focusingon making formula feeding safer by encouraging women to boil water andfeed their infants using cups. Tlou also said the ministry will monitornew studies to determine whether a new policy is needed. "We areamenable to research, especially our own research," she said (Washington Post, 7/23).
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