Breast feeding and HIV transmission

• the risk of an HIV positive mother transmitting HIV to her breast fed child is estimated at 15% (1) For this reason, in the developed world the recommendation is that HIV positive mothers do not breastfeed their infants. However, in the developing world the excess risk to the infant from not having breast milk are felt to outweigh risk of transmission
• in UK, the department of health advices that in situations where it is possible to have uninterrupted access to infant formula and the risk of contamination during the preparation of infant formula can be minimized, HIV infected women should not breastfeed in order to reduce the risk of transmission (2)
  • the risk of HIV transmission through breast feeding may vary according to
    • clinical and immunological status of the mother
    • plasma and breast milk viral load
    • breast health – subclinical and clinical mastitis, cracked nipples (2)
  • there is lack of evidence to prove that the risk of transmission is greater or lesser with colostrum than in later milk (2)
  • evidence of HIV transmission, late in breastfeeding has been shown in some studies
    • about one in ten infants who were uninfected at 4 weeks of age were positive for HIV by the age of 18-24 months (2)
• there is evidence that in HIV positive mothers, the risk of transmitting HIV to their breast fed children was highest during the childs first 6 months of life (2). This study revealed that higher parity and older maternal age were associated with a reduced risk of transmission
• the risk of transmission through breast milk is greater in mother’s who are infected with HIV during the breastfeeding period (due to the high viral load) than in mothers who are already infected (2)
  • therefore uninfected breastfeeding mothers who are at a risk of exposure to HIV should be given proper advice and support to decrease the possibility of acquiring the infection while breastfeeding (2)
• a more recent study revealed that early, abrupt weaning did not reduce the risk of HIV transmission or mortality in breast-fed infants or mothers with HIV (3)
  • early, abrupt cessation of breast-feeding by HIV-infected women in a low-resource setting, such as Lusaka, Zambia, does not improve the rate of HIV-free survival among children born to HIV-infected mothers and is harmful to HIV-infected infants
• under special circumstances if a women with HIV decides to breastfeed,
  • an expert professional advice should be sought on reducing the risk of transmission of HIV through breastfeeding e.g. – antiretroviral therapy for mother and child, early discontinuation of breastfeeding,
  • the mother should be well informed and motivated
  • she should be encouraged to breast feed exclusively (2)

Reference:

• (1) Joint policy statement on HIV and infant feeding (1999): WHO, UNICEF, UNAIDS Statement on Current Status of WHO/UNAIDS/UNICEF Policy Guidelines. Geneva, September 1999.
• (2) Department of Health (DH) 2004. HIV and Infant Feeding: Guidance from the UK Chief Medical Officers' Expert Advisory Group on AIDS
• (3) Miotti PG, Taha TE, Kumwenda NI et al. HIV transmission through breastfeeding: a study in Malawi. JAMA 1999; 25(282): 744-9.
• (4) Kuhn L et al. Effects of early, abrupt weaning on HIV-free survival of children in ZambiaN Engl J Med. 2008 Jul 10;359(2):130-41