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Should a Mother With HIV Breastfeed Her Baby?

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WebMD Health News

Nov. 16, 1999 (Atlanta) -- The risk of passing HIV infection along to a newborn through mother's milk is greatest in the early months of breastfeeding, according to a study in a recent issue of the Journal of the American Medical Association.

In the U.S., breastfeeding is not recommended for new mothers infected with HIV, which can spread to the baby through the mother's milk. But the study's findings are likely to have a strong impact on international recommendations for limiting the spread of the disease." In the U.S., specific recommendations for HIV-infected women are not to breastfeed," researcher Paolo Miotti, MD, tells WebMD. "So the [study findings] are much more important for developing countries, where breastfeeding is almost universal." Miotti is a medical officer, division of AIDS, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Md.

In 1998, the Joint United Nations Programme on HIV/AIDS issued a revised statement suggesting 1) that women be offered HIV testing and counseling, 2) that they be notified of the benefits and risks of breastfeeding if the mother is HIV-infected, and 3) that they make a decision [about breastfeeding] based on individual and family situations.

The reported study was done to provide further information about breastfeeding timing vs. the risk of infant HIV infection. "We found that the risk [of HIV transmission through breastfeeding] was more in the first six months of the life of the baby than later on," Miotti says. "[But] babies can catch HIV through breast milk as long as they are breastfed."

The three-year study was conducted at a postnatal hospital clinic in Malawi, a country in southern Africa where it's estimated that 30% of nursing women are infected with HIV.

The researchers studied 672 infants -- HIV-negative at birth -- born to HIV-infected women who had not been treated with antiretroviral (anti-HIV) drugs during or after pregnancy. The frequency of occurrence, timing, and risk factors of HIV transmission through breast milk were measured until the infants were 2 years old.

While breastfeeding, 7% (47) of the infants became infected with HIV; after breastfeeding stopped among the mothers in the study, there were no additional new infections. "It's believed that breastfeeding roughly doubles the number of HIV-infected babies," says Miotti.

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.

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