Should a Mother With HIV Breastfeed Her Baby?
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The researchers also found that new mothers who already had a number of children and/or who were somewhat older than the other mothers studied had a lower risk of transmitting HIV to their newborns through breastfeeding -- possibly due to their greater previous breastfeeding experience. The researchers write that the study probably underestimated the postnatal HIV transmission rate, because their measurements did not include infections contracted during the early days and weeks of breastfeeding, when infection rates can be very high.
In the same issue, the authors of an editorial discussing the study explain why the risk of HIV transmission may decline over the course of breastfeeding. "Colostrum and mature milk contain different types of cells and different concentrations of factors associated with immunity, e.g. vitamin A, immunoglobulins, and lactoferrin, all of which may play a role in protecting against HIV transmission to infants," they write. "[Also,] the [immune status] of younger vs. older infants may play a role in susceptibility to infection." The editorial was written by Mary Glenn Fowler, MD, MPH, and colleagues at the CDC's Division of HIV/AIDS Prevention -- Surveillance/Epidemiology.
One recommendation to stop the transmission of HIV to breastfeeding infants internationally would be: Don't breastfeed if you are infected with HIV. But in developing countries around the world, says Miotti, bottle feeding is a very expensive and impractical solution. Prepared infant formula also may be contaminated by local water supplies. Additionally, Fowler and her group write that in more primitive societies, there may be a social stigma attached to mothers who do not breastfeed, possibly leading to their being harmed or even abandoned.
Miotti says that early weaning is a possible solution to lessen the chances of HIV transmission. Often in Africa and other developing countries, women breastfeed for as long as two years. But, he says, "there is no compelling reason for [breastfeeding] much beyond six months, for nutritional purposes and otherwise."
Another approach, according to Miotti, would be to determine whether antiviral drugs can be given to HIV-infected women who breastfeed -- to kill the virus that is in the breast milk. The division of AIDS at NIAID is funding a project that will investigate this, he says.