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Breast-feeding and HIV transmission

Published online by Cambridge University Press:  14 December 2007

Anna Coutsoudis
Anna Coutsoudis*
Affiliation:
Department of Paediatrics and Child Health, University of Natal, Private Bag 7, Congella 4013, South Africa
*
Corresponding author: Professor A. Coutsoudis, fax +27 31 2604388, email coutsoud@nu.ac.za
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Abstract

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HIV-1 (subsequently referred to as HIV) infection may be transmitted to the infant during breast-feeding. The risk of transmission varies with stage of maternal infection, duration of breast-feeding, type of breast-feeding (i.e. exclusive or mixed breast-feeding), and breast pathology. Recent studies support the findings of a meta-analysis (Dunn et al. 1992) and indicate that when breast-feeding is practised for over 2 years, the risk of infection is about 14%. Shorter durations of breast-feeding may therefore minimize the risk of transmission. Although the risk of infection appears to be greatest in the first 6 months this risk needs to be weighed against the excess risk of morbidity and mortality if children are not breast-fed in the first 6 months. In resource-poor settings any policy decision to replace breast-feeding with formula feeding in order to prevent postnatal HIV transmission needs to be balanced against the risks to the infant of malnutrition, morbidity and death if not breast-fed. New information suggests that exclusive breast-feeding, instead of the norm of mixed breast-feeding, may not increase risk of HIV transmission at 6 months and suggests that exclusive breast-feeding with early cessation may be a viable option for some women. The present review suggests options for reducing risk of HIV transmission through breast-feeding. Finally, current knowledge points to the dangers of large-scale replacement feeding programmes in contexts where women will have low education, poor access to water and health services, and strong cultural pressures to breast-feed. Emphasising replacement feeding in these contexts may fuel the mixed breast-feeding practice for mothers who will have no other choice than breast-feeding, yet will try to follow the recommendations applied to replacement feed.

Keywords

Breast-feedingHIV infectionInfant nutrition
Type
Research Article
Information
Nutrition Research Reviews , Volume 14 , Issue 2 , December 2001 , pp. 191 - 206
Copyright
Copyright © CABI Publishing 2001

References

Andreasson, P-A, Dias, F, Naucler, A, Andersson, S & Biberfeld, G (1993) A prospective study of vertical transmission of HIV-2 in Bissau, Guinea-Bissau. AIDS 7, 989–993.Google ScholarPubMed
Bertolli, J, St Louis, ME, Simonds, RJ, Nieburg, P, Kamenga, M, Brown, C, Tarande, M, Quinn, T & Ou, CY (1996) Estimating the timing of mother-to-child transmission of human immunodeficiency virus in a breast-feeding population in Kinshasa, Zaire. Journal of Infectious Diseases 174, 722–726.CrossRefGoogle Scholar
Bobat, R, Moodley, D, Coutsoudis, A & Coovadia, HM (1997) Breastfeeding by HIV-1 infected women and outcome in their infants: a cohort study from Durban, South Africa. AIDS 11, 1627–1633.Google Scholar
Bulterys, M, Chao, A & Dushimimana, A (1995) HIV-1 seroconversion after 20 months of age in a cohort of breastfed children born to HIV-1 infected women in Rwanda (letter). AIDS 9, 93–94.Google Scholar
Chopra, M, Schaay, N & Piwoz, E (2000) What is the impact of an AZT programme on breastfeeding and infant care counseling and practices amongst health providers and HIV-infected women in Khayelitsha, South Africa? Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, MoOrD203Abstr.Google Scholar
Coutsoudis, A, Pillay, K, Kuhn, L, Spooner, E, Tsai, W-Y & Coovadia, HM (2001) Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS 15, 379–387.CrossRefGoogle ScholarPubMed
Coutsoudis, A, Pillay, K, Spooner, E, Kuhn, L & Coovadia, HM (1999) Randomized trial testing the effect of vitamin A supplementation on pregnancy outcomes and early mother-to-child transmission in Durban, South Africa. AIDS 13, 1517–1524.Google Scholar
Datta, P, Embree, J & Kreiss, J (1992) Resumption of breast-feeding in later childhood: a risk factor for mother to child human immunodeficiency virus type 1 transmission. Journal of Paediatric Infectious Diseases 11, 974–976.Google ScholarPubMed
De Jong, MD, de Boer, RJ, de Wolf, F, Foudraine, NA, Boucher, CA, Goudsmit, J & Lange, JM (1997) Overshoot of HIV-1 viraemia after early discontinuation of antiretroviral treatment. AIDS 11, F79–F84.CrossRefGoogle ScholarPubMed
De Martino, M (1994) The Italian register for HIV infection in children. Human immunodeficiency virus type 1 infection and breastmilk. Acta Paediatrica 400, S51–S58.Google Scholar
Dunn, TDT, Newell, ML, Ades, AE & Peckham, CS (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 340, 585–588.CrossRefGoogle ScholarPubMed
Ekpini, E, Wiktor, SZ, Satten, GA, Adjorlolo-Johnson, GT, Sibailly, TS, Ou, CY, Karon, JM, Brattegaard, K, Whitaker, JP, Gnaore, E, De Cock, KM & Greenberg, AE (1997) Late postnatal mother-to-child transmission of HIV-1 in Abidjan, Cote d'Ivoire. Lancet 349, 1054–1059.CrossRefGoogle ScholarPubMed
Embree, JE, Nienga, S, Datta, P, Nagelkerke, NJ, Ndinya-Achola, JO, Mohammed, Z, Ramdahin, S, Bwayo, JJ & Plummer, Fa (2000) Risk factors for postnatal mother-child transmission of HIV-1. AIDS 14, 2535–2541.CrossRefGoogle ScholarPubMed
Ford, RPK, Taylor, BJ, Mitchell, EA, Enright, SA, Stewart, AW, Becroft, DM, Scragg, R, Hassall, IB, Barry, DM & Allen, EM et al. (1993) Breastfeeding and the risk of sudden infant death syndrome. International Journal of Epidemiology 22, 885–890.Google Scholar
Gray, G (2000) The PETRA study: early and late efficacy of three short ZDV/3TC combination regimens to prevent mother-to-child transmission of HIV-1. Proceedings of the XIIIth International AIDS conferenceDurban, South Africa, LbOr5Abstr.Google Scholar
Green, C (1999) Improving Breastfeeding Behaviors: Evidence from Two Decades of Intervention Research. Washington, DC: LINKAGES/Academy for Educational Development.Google Scholar
Guay, LA, Musoke, P, Fleming, T, Bagenda, D, Allen, M, Nakabiito, C, Sherman, J, Bakaki, P, Ducar, C, Desayve, M, Emel, L, Mirochnick, M, Fowler, MG, Mofenson, L, Miolti, P, Dransfield, K, Bray, D, Mmiro, F & Jackson, JB (1999) Intrapartum and neonatal single-dose nevirapine compared with zidovudine for prevention of mother-to-child transmission of HIV-1 in Kampala, Uganda: HIVNET 012 randomised trial. Lancet 354, 795–802.Google Scholar
Gwinn, ML, Lee, NC, Rhodes, PH, Layde, PM & Rubin, GL (1990) Pregnancy, breast feeding and oral contraceptives and the risk of epithelial ovarian cancer. International Journal of Epidemiology 43, 559–568.Google Scholar
Harmsen, MC, Swart, PJ, de Berthune, MP, Pauwels, R, De Clercq, E, The, TH & Meijer, DK (1995) Antiviral effect of plasma and milk proteins: lactoferrin shows potent activity against both human immunodeficiency virus and cytomegalovirus replication in vitro. Journal of Infectious Diseases 172, 380–385.CrossRefGoogle ScholarPubMed
Howett, MK, Stoltzfus, S, Berlin, CM Jr & Wigdahl, B (2000) Inactivation of HIV in milk by alkyl sulfate microbicides. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa LbPp123Abstr.Google Scholar
Jeffery, B, Webber, L & Mokhondo, R (2000) Determination of effectiveness of inactivation of HIV in human breastmilk by Pretoria Pasteurisation. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, MoPeB2201Abstr.Google Scholar
Joint United Nations Programme on HIV/AIDS (2000) Report on the Global HIV/AIDS Epidemic. Geneva: UNAIDS/ WHO.Google Scholar
Jorgensen, AF & Boisen, F (2000) Pasteurization of HIV contaminated breastmilk. Proceedings of XIIIth International AIDS ConferenceDurban, South Africa LbPp122Abstr.Google Scholar
Karjalainen, J, Martin, JM, Knip, M, Honen, J, Robinson, BH, Savilahti, E, Akerblom, HK & Dosch, HM (1992) A bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. New England Journal of Medicine 327, 302–307.CrossRefGoogle ScholarPubMed
Karlsson, K & Massawe, A, Urassa, E, Kawo, G, Msemi, G, Kazimoto, T, Lyamuya, E, Mbena, E, Urassa, W, Bredberg-Raden, U, Mhalu, F & Biberfeld, G (1997) Late postnatal transmission of human immunodeficiency virus type I infection from mothers to infants in Dar es Salaam, Tanzania. Journal of Paediatric Infectious Diseases 16, 963–967.CrossRefGoogle ScholarPubMed
Krou-Danho, N, Sibailly, TS, Bertolli, J, Boni-Ouattara, E, Ekpini, ER, Nkengasong, J, Maurice, C, Monga, B, Roels, TH & Greenberg, AE (2000) Changes in breastmilk and plasma HIV-1 viral load during the first 6 weeks postpartum in HIV-infected women receiving short-course oral zidovudine in Abidjan, Cote d'Ivoire. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, WeOrC493Abstr.Google Scholar
Kuhn, L, Coutsoudis, A, Meddows-Taylor, S, Mngqundaniso, N, Trabattoni, D, Clerici, M, Shearer, G, Tiemessen, C & Gray, G (2000) HIV-specific T-helper cell responses in infants of HIV-infected mothers exposed or not to anti-retroviral treatment. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, TuOrA282Abstr.Google Scholar
Kuhn, L & Stein, Z (1997) Infant survival, HIV infection, and feeding alternatives in less developed countries. American Journal of Public Health 87, 926–931.CrossRefGoogle ScholarPubMed
Labbock, M, Perez-Escamilla, R, Peterson, A & Coly, S (1997) Breastfeeding and Child Spacing Country Profiles. Washington, DC: Institute for Reproductive Health.Google Scholar
Lanting, CI, Fidler, V, Huisman, M, Touwen, BCL & Boersma, ER (1994) Neurological differences between 9-year-children fed breastmilk or formula-milk as babies. Lancet 344, 1319–1322.CrossRefGoogle ScholarPubMed
Lawrence, RA (1994) Breastfeeding: A Guide for the Medical Profession, 4th ed. St Louis, MO: Mosby.Google Scholar
Lepage, P, Van de Perre, , Simonon, A, Msellati, P, Hitimana, DG & Dabis, F (1992) Transient seroconversion in children born to HIV-1 infected mothers. Journal of Paediatric Infectious Diseases 11, 892–894.Google Scholar
Leroy, V, Newell, ML, Dabis, F, Peckham, C, Van de Perre, P, Bulterys, M, Kind, C, Simonds, RJ, Wiktor, S & Msellati, P (1998) International multicentre pooled analysis of late postnatal mother-to-child HIV-1 infection. Lancet 352, 597–600.Google Scholar
Lucas, A, Morley, R, Cole, TJ, Lister, G & Leeson-Payne, C (1992) Breastmilk and subsequent intelligence quotient in children born preterm. Lancet 339, 261–264.Google Scholar
Mbori-Ngacha, D, Nduati, R, John, G, Reilly, M, Mwatha, A, Overbaugh, J, Welch, M, Ndinya-Achola, J, Bwayo, J & Kreiss, J (2000) Morbidity and mortality in breastfed and formula fed infants of HIV-1 infected women: results of a randomized clinical trial. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, WeOrC494Abstr.Google Scholar
Miotti, PG, Taha, TET, Kumwenda, NI, Broadhead, R, Mtimavalye, LA, Van der Hoeven, L, Chiphangwi, JD, Liomba, G & Biggar, RJ (1999) HIV transmission through breastfeeding: a study in Malawi. Journal of the American Medical Association 282, 744–749.CrossRefGoogle ScholarPubMed
Mofenson, LM & McIntyre, JA (2000) Advances and research directions in the prevention of mother-to-child HIV-1 transmission. Lancet 355, 2237–2244.CrossRefGoogle ScholarPubMed
Moodley, D (2000) The SAINT Trial: Nevirapine (NVP) versus zidovudine (ZDV) + lamivudine (3TC) in prevention of peripartum HIV transmission. Proceedings of the XIIIth International AIDS conferenceDurban, South Africa, LbOr2Abstr.Google Scholar
Morrow, AL, Guerrero, ML, Shults, J, Calva, JJ, Lutter, C, Bravo, J, Ruiz-Palacios, G, Morrow, RC & Butterfoss, FD (1999) Efficacy of home-based peer counselling to promote exclusive breastfeeding: a randomised controlled trial. Lancet 353, 1226–1231.Google Scholar
Nduati, R, John, G, Mbori-Ngacha, D, Richardson, B, Overbaugh, J, Mwatha, A, Ndinya-Achola, J, Bwayo, J & Onyango, FE, Hughes, J & Kreiss, J (2000 a) Effect of breastfeeding and formula feeding on transmission of HIV-1: A randomized clinical trial. Journal of the American Medical Association 283, 1167–1174.Google Scholar
Nduati, R, Richardson, B, John, G, Overbaugh, J, Welch, M, Ndinya-Achola, J, Moses, S, Holmes, K, Onyango, F & Kreiss, JK (2000 b) Impact of breastfeeding on maternal mortality among HIV-1 infected women: Results of a randomized clinical trial. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, WeOrC495Abstr.Google Scholar
Newburg, DS, Viscidi, RP, Ruff, A & Yolken, RH (1992) A human milk factor inhibits binding of the human immunodeficiency virus to the CD4 receptor. Pediatric Research 31, 22–28.Google Scholar
Newcomb, PA, Storer, BE, Longnecker, MP, Mittendorf, R, Greenberg, ER, Clapp, RW, Burke, KP, Willett, WC & MacMahon, B (1994) Lactation and reduced risk of premenopausal breast cancer. New England Journal of Medicine 330, 81–87.Google Scholar
Owor, M, Deseyve, M, Duefield, C, Musisi, M, Fleming, T, Musoke, P, Guay, L, Mmiro, F & Jackson, B (2000) The one year safety and efficacy data of the HIVNET 012 trial. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, LbOr1Abstr.Google Scholar
Pillay, K, Coutsoudis, A, York, D, Kuhn, L & Coovadia, HM (2000) Cell-free virus in breast milk of HIV-1 seropositive women. Journal of AIDS 24, 330–336.Google Scholar
Semba, RD, Kumwenda, N, Hoover, DR, Taha, TE, Quinn, TC, Mtimavalye, L, Biggar, RJ, Broadhead, R, Miotti, PG, Sokoll, LJ, van der Hoeven, L & Chiphangwi, JD (1999) Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. Journal of Infectious Diseases 180, 93–98.Google Scholar
Shaffer, N, Chuachoowong, R, Mock, PA, Bhadrakon, C, Siriwasin, W, Young, NL, Chotpitayasunondh, T, Chearskul, S, Roongpisuthipong, A, Chinayon, P, Karon, J, Mastro, TD & Simonds, RJ (1999) Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Lancet 353, 773–780.CrossRefGoogle ScholarPubMed
Smith, MM & Kuhn, L (1999) Infant feeding patterns and HIV transmission (letter). Lancet 354, 1903–1904.Google Scholar
Taren, D, Nahlen, B, van Eijk, A & Otiena, J (2000) Early introduction of mixed feedings and postnatal HIV transmission. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, MoPeB2200Abstr.Google Scholar
Tess, BH, Rodrigues, LC, Newell, ML, Dunn, DT & Lago, TD (1998) Infant feeding and risk of mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. Sao Paulo Collaborative Study for vertical transmission of HIV-1. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 12, 513–520.Google Scholar
Thapa, S, Short, RV & Potts, M (1988) Breast feeding, birth spacing and their effects on child survival. Nature 335, 679–682.CrossRefGoogle ScholarPubMed
Thomas, DB & Noonan, EA (1993) Breast cancer and prolonged lactation. International Journal of Epidemiology 22, 619–626.CrossRefGoogle ScholarPubMed
Valdes, V, Pugin, E, Schooley, J, Catalan, S & Aravena, R (2000) Clinical support can make the difference in exclusive breastfeeding success among working women. Journal of Tropical Paediatrics 46, 149–154.Google Scholar
Van de Perre, P (1999) Transmission of Human Immunodeficiency Virus Type 1 through breastfeeding: How can it be prevented. Journal of Infectious Diseases 179, S405–S407.CrossRefGoogle ScholarPubMed
Van de Perre, P, Simonon, A, Msellati, P, Hitimana, DG, Vaira, D, Bazubagira, A, Van Goethem, C, Stevens, AM, Karita, E & Sondag-Thall, D et al. (1991) Post-natal transmission of human immunodeficiency virus type 1 from mother to infant. New England Journal of Medicine 325, 593–598.CrossRefGoogle Scholar
Wahl, SM, McNeely, TB, Janoff, EN, Shugars, D, Worley, P, Tucker, C & Orenstein, JM (1997) Secretory leucocyte protease inhibitor (SLPI) in mucosal fluids inhibits HIV-1. Oral Diseases 3, S64–S69.CrossRefGoogle Scholar
World Health Organization (1991) Indicators for assessing breastfeeding practices. Geneva, Switzerland: WHO/CHD/SER/91.4.Google Scholar
World Health Organization Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality (2000) Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet 355, 451–455.CrossRefGoogle Scholar
World Health Organization/Joint United Nations Programme on HIV/AIDS/UNICEF (1998) HIV and Infant Feeding. Guidelines for Decision-makers. Geneva. WHO/UNAIDS/UNICEF.Google Scholar
Wiktor, SA, Leroy, V, Ekpini, ER, Alioum, A, Karon, J, Msellati, P, Hudgens, M, Meda, M & Greenberg, AE (2000) 24-month efficacy of short-course maternal zidovudine for the prevention of mother-to-child HIV-1 transmission in a breastfeeding population: A pooled analysis of two randomized clinical trials in West Africa. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, TuOrB354Abstr.Google Scholar
Willumsen, J, Filteau, S, Coutsoudis, A, Newell, M-L, Dwarika, S, York, D & Tomkins, A (2000) Subclinical mastitis associated with increased breastmilk viral load. Proceedings of the XIIIth International AIDS ConferenceDurban, South Africa, TuPeC3448Abstr.Google Scholar
Ziegler, JB, Cooper, DA, Johnson, RO & Gold, J (1985) Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet i, 896–898.Google Scholar