FEEDING INFANTS OF HIV-POSITIVE MOTHERS

7. FEEDING INFANTS OF HIV-POSITIVE MOTHERS

The risk of intrauterine and intrapartum mother-to-child transmission (MTCT) of HIV in term newborn infants, who were born to mothers who are known to be HIV-positive and who have not taken antiretroviral medi- cation, has been described as 20–30% (363, 364). The risk of MTCT through human milk in term newborn infants, born to mothers who are known to be HIV-positive and who

have not taken antiretroviral medication, is 10–15% (363, 364).

The risk of delivering a LBW infant is higher in HIV-positive women than in HIV- negative women (365). The risk of MTCT through human milk may be higher in LBW than non-LBW infants as the mother may have additional risk factors for transmission (e.g. a sexually transmitted infection, masti- The risk of delivering a LBW infant is higher in HIV-positive women than in HIV- negative women (365). The risk of MTCT through human milk may be higher in LBW than non-LBW infants as the mother may have additional risk factors for transmission (e.g. a sexually transmitted infection, masti-

first months of life (367). A recent study from higher risk of becoming HIV-infected during

Zimbabwe supports this observation (369). intrapartum and early breastfeeding periods

HIV transmission rates/100 child-years at 6 in pre-term infants than in infants born after

months were 5.1 for exclusive breastfeeding,

6.7 for predominant breastfeeding, and 10.5 from replacement feeding are also likely to be

37 weeks (366–368). The risks of infection

for mixed feeding. However, some studies have higher in LBW than non-LBW infants as the

questioned a causal link and have provided data former have a higher risk of impaired immu-

suggesting the potential for reverse causality, nity and of infection (see sections 2.1 and

i.e. infants who are HIV-positive and unwell 2.3). Thus, the balance of benefits and risks of

are more likely not to be exclusively breastfed breastfeeding in LBW infants may be similar

(370). There are no data on the risks of HIV to that in non-LBW infants.

transmission in infants who moved from for- HIV-infected mothers of LBW infants may

mula/mixed feeding to EBF early in life. not know their HIV status at the time of birth,

No data were located that examined the especially if this is earlier than expected. Fur-

impacts of heat treatment of mother’s own milk ther, even if the mother knows her HIV sta-

in HIV-positive mothers of LBW infants. In tus she may not have received HIV and infant

non-LBW infants, heat treatment by flash and feeding counselling.

Pretoria pasteurization methods inactivates We looked for published studies on the fol-

HIV (76–79). Both methods have been shown lowing issues:

to reduce HIV-1 by >3 logs and eliminate bac- • Choice of milk in infants born to HIV-

terial contaminants, while flash treatment positive mothers;

resulted in undetectable reverse transcriptase • Counselling on infant feeding for HIV-

activity (76–79). Neither method was reported positive mothers of LBW infants.

to cause significant decrease in any vitamin, lactoferrin or lysozyme. These methods could

be implemented by a mother in a developing Results country, but studies have shown that accept-

Effects on mortality,

ability is variable (371, 372).

neurodevelopment and malnutrition

No studies were located which examined the

Recommendations

impact of choice of milk or counselling on The current UN recommendations on feeding HIV and infant feeding on mortality rates,

infants of HIV-positive women are replace- severe morbidity, neurodevelopment and

ment feeding when this is acceptable, feasible, malnutrition/growth in LBW infants born to

affordable, sustainable and safe, or EBF for the HIV-positive mothers.

first few months of life and cessation of breast- feeding as early as possible. There is no differ-

Effects on serious morbidity – HIV

ence in the recommendations for normal and

transmission

LBW infants. It was not possible to provide There is evidence from observational studies

additional recommendations due to insuffi- in South Africa that the risk of HIV transmis-

cient evidence.

sion is lower if infants are exclusively breastfed

OPTIMAL FEEDING OF LOW-BIRTH-WEIGHT INFANTS: TECHNICAL REVIEW

ANNEX 1