Breastfeeding difficulties

[LOS ANGELES] The benefits of breastfeeding outweigh the risks of virus transmission from HIV-positive mothers to their children, according to studies conducted in four African nations.

Avoiding transmission of HIV from mother to child after birth has become one of the greatest challenges in HIV prevention. Approaches to date to reduce or prevent postnatal transmission through breastfeeding have included the avoidance of all breastfeeding through the use of exclusive replacement feeds, or exclusive breastfeeding for a limited duration with early and rapid cessation of breastfeeding as soon as it is feasible.

Although experts say that breastfeeding gives children the best start in life, protecting them from life-threatening diseases and providing essential nutrients, barely a third of all infants in developing countries are exclusively breastfed for the first six months.

WASHINGTON, June 22 /U.S. Newswire/ -- An Academy for Educational Development project significantly improved child health in five countries, as measured by double-digit gains in key breastfeeding practices.

Poor infection control at dental, maternity and paediatric facilities is possibly contributing to the spread of HIV/AIDS, statistics showed on Tuesday.

For many HIV-positive mothers in resource-poor settings, breastfeeding is often the only option, despite the risk of HIV transmission. The challenge now is for healthcare workers to accept this reality and make breastfeeding safer, a recent report has said.

Dr Libertina Amathila, Minister of Health and Social Services has launched the National Policy on Infant and Young Child Feeding in Windhoek.

The issues surrounding the choice of infant feeding in HIV positive women is very complex, as the report on the PMTCT Pilot Sites (released by HST last week) explains. There is clearly not consensus internationally on the best approach for low-resource settings, and even existing research results provide conflicting evidence. A number of letters were published in JAMA this week in response to the results of the trial, Morbidity and Mortality in Breastfed and Formula-Fed Infants of HIV-1 Infected Women A Randomized Clinical Trial published last year in JAMA [http://jama.ama-assn.org/issues/v286n19/abs/joc10358.html] The conclusion reached by the researchers was: Conclusions: In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1 free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1 infected mothers in a resource-poor setting. However the responses raise a number of issues and potential problems with the trial methodology, which can be read at http://jama.ama-assn.org/issues/v287n9/ffull/jlt0306-2.html A number of posters and abstracts from the 9th Conference on Retroviruses and Opportunistics Infections (24-28 Feb 2002 http://63.126.3.84/2002/) covered issues of relevance including: Breastmilk HIV-1 Viral Load Is Associated with Viral Load in Other Compartments, Host Genotype, and Perinatal Transmission http://63.126.3.84/2002/Abstract/12760.htm Factors Associated with Vertical Transmission in a Cohort of HIV+ Pregnant Women in Rio de Janeiro, Brazil http://63.126.3.84/2002/Abstract/12832.htm On the training side, a set of online tutorials from ReproLine provide powerpoint slides, text transcripts and multi-media references on a number of topics relating to the Care of Women Living with HIV in Limited-Resource Settings. One of these tutorials covers breastfeeding and the range of international research and knowledge in this area. Available from http://www.reproline.jhu.edu/english/4morerh/4hivaid/hivreal.htm.