FEEDING INFANTS BORN TO HIV POSITIVE MOTHERS IN AFRICA: BALANCING THE RISKS

Jean Humphrey, ScD
Professor, Department of International Health,
John Hopkins Bloomburg School of Public Health

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In Africa, breastfeeding by HIV-positive mothers is a controversial topic.  Breastfeeding significantly increases the likelihood that HIV will be transmitted from mother to infant, but in many parts of Africa, not breastfeeding increases the likelihood that an infant will die of malnutrition or disease.  One million children are currently living with HIV acquired during breastfeeding, but at the same time, nutritious and safe substitutes for breast milk are often unavailable.  For many HIV-positive mothers, every feeding option carries substantial risks, and these risks must be carefully balanced.

Until very recently, the World Health Organization (WHO) recommended that HIV-positive mothers completely avoid breastfeeding, if possible.  This recommendation was strongly influenced by a trial conducted in Nairobi, Kenya, showing that breastfeeding increased the rate of HIV transmission.  More recent studies, however, have tracked death rates in addition to infection rates, and these studies have shown that a child’s chance of surviving and avoiding HIV infection is almost the same whether the child is breastfed or not.  An outbreak of infant diarrhea that occurred in Botswana in 2006 confirmed suspicions that government-sponsored programs to replace breast milk with baby formula were not saving lives.  A study conducted in Zimbabwe by Jean Humphrey, ScD, showed that infants who were exclusively breastfed during the first six months of life had the best chance of surviving infection-free.  In light of these results, the WHO changed the phrasing of its guidelines on breastfeeding to emphasize that HIV-positive mothers should exclusively breastfeed unless a safe and nutritious alternative is available. 

Many scientists are unsatisfied with the current dilemma that many African mothers face and are investigating new strategies to improve the situation.  One recent study showed that mother-to-child HIV transmission is reduced if nursing mothers receive highly active antiretroviral therapy (HAART), and virus-killing treatments for breast milk, such as flash heating, are also being explored.