Skip to main content
SpringerLink
Log in
Book cover

Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding pp 289–297Cite as

Should Women with HIV-1 Infection Breastfeed Their Infants? It Depends on the Setting

  • Chapter
  • First Online:

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 743))

Abstract

Breastfeeding is the ideal infant food—it provides both optimal nutrition and numerous factors that contribute to infant immunity, growth, cognition, and health. It also enhances maternal–infant bonding and child-spacing and may provide long-term benefits to mothers. An estimated 7.7 million children under 5 years of age die annually, with >30% dying of infectious diseases [1, 2]. Breastfeeding has been identified as the most effective intervention to prevent under-5 mortality [3]. It was therefore a huge public health and policy challenge to discern the best infant feeding strategy when it was discovered that HIV-1 could be transmitted through breastfeeding. While nonbreastfeeding could entirely prevent transmission of a rapidly fatal infection, implementation of artificial feeding could be associated with increased infant mortality and morbidity. Over the past two decades, mothers, clinicians, and policy makers have wrestled with balancing infant risk of HIV-1 acquisition against risk of infant mortality in the context of concurrently changing interventions that decrease transmission of HIV-1.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Rajaratnam JK, Marcus JR, Flaxman AD et al (2010) Neonatal, postneonatal, childhood, and under-5 mortality for 187 countries, 1970–2010: a systematic analysis of progress towards Millennium Development Goal 4. Lancet 375:1988–2008

    Article  PubMed  Google Scholar 

  2. UN (2010) The millennium development goals report. p 27

    Google Scholar 

  3. Labbok MH, Clark D, Goldman AS (2004) Breastfeeding: maintaining an irreplaceable immunological resource. Nat Rev Immunol 4:565–572

    Article  PubMed  CAS  Google Scholar 

  4. UNAIDS (2010) Report on the Global HIV/AIDS epidemic

    Google Scholar 

  5. De Cock KM, Fowler MG, Mercier E et al (2000) Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA 283:1175–1182

    Article  PubMed  Google Scholar 

  6. Shapiro RL, Hughes MD, Ogwu A et al (2010) Antiretroviral regimens in pregnancy and breast-feeding in Botswana. N Engl J Med 362:2282–2294

    Article  PubMed  CAS  Google Scholar 

  7. WHO (2010) Guidelines on HIV and infant feeding: principles and recommendations for infant feeding in the context of HIV and a summary of evidence

    Google Scholar 

  8. Dunn DT, Newell ML, Ades AE, Peckham CS (1992) Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet 340:585–588

    Article  PubMed  CAS  Google Scholar 

  9. Van de Perre P, Simonon A, Msellati P et al (1991) Postnatal transmission of human immunodeficiency virus type 1 from mother to infant. A prospective cohort study in Kigali, Rwanda. N Engl J Med 325:593–598

    Article  PubMed  Google Scholar 

  10. Nduati R, John G, Mbori-Ngacha D et al (2000) Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial. JAMA 283:1167–1174

    Article  PubMed  CAS  Google Scholar 

  11. Rousseau CM, Nduati RW, Richardson BA et al (2004) Association of levels of HIV-1-infected breast milk cells and risk of mother-to-child transmission. J Infect Dis 190:1880–1888

    Article  PubMed  Google Scholar 

  12. Rousseau CM, Nduati RW, Richardson BA et al (2003) Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 187:741–747

    Article  PubMed  Google Scholar 

  13. Semba RD, Kumwenda N, Hoover DR et al (1999) Human immunodeficiency virus load in breast milk, mastitis, and mother-to-child transmission of human immunodeficiency virus type 1. J Infect Dis 180:93–98

    Article  PubMed  CAS  Google Scholar 

  14. Miotti PG, Taha TE, Kumwenda NI et al (1999) HIV transmission through breastfeeding: a study in Malawi. JAMA 282:744–749

    Article  PubMed  CAS  Google Scholar 

  15. Coutsoudis A, Dabis F, Fawzi W et al (2004) Late postnatal transmission of HIV-1 in breast-fed children: an individual patient data meta-analysis. J Infect Dis 189:2154–2166

    Article  PubMed  Google Scholar 

  16. John GC, Nduati RW, Mbori-Ngacha DA et al (2001) Correlates of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission: association with maternal plasma HIV-1 RNA load, genital HIV-1 DNA shedding, and breast infections. J Infect Dis 183:206–212

    Article  PubMed  CAS  Google Scholar 

  17. Humphrey JH, Marinda E, Mutasa K et al (2010) Mother to child transmission of HIV among Zimbabwean women who seroconverted postnatally: prospective cohort study. BMJ 341:c6580

    Article  PubMed  Google Scholar 

  18. Coutsoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. South African Vitamin A Study Group. Lancet 354:471–476

    Article  PubMed  CAS  Google Scholar 

  19. Coovadia HM, Rollins NC, Bland RM et al (2007) Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 369:1107–1116

    Article  PubMed  Google Scholar 

  20. Iliff PJ, Piwoz EG, Tavengwa NV et al (2005) Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS 19:699–708

    Article  PubMed  Google Scholar 

  21. Kuhn L, Sinkala M, Kankasa C et al (2007) High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission. PLoS One 2:e1363

    Article  PubMed  Google Scholar 

  22. Connor EM, Sperling RS, Gelber R et al (1994) Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med 331:1173–1180

    Article  PubMed  CAS  Google Scholar 

  23. Wiktor SZ, Ekpini E, Karon JM et al (1999) Short-course oral zidovudine for prevention of mother-to-child transmission of HIV-1 in Abidjan, Cote d’Ivoire: a randomised trial. Lancet 353:781–785

    Article  PubMed  CAS  Google Scholar 

  24. Chung MH, Kiarie JN, Richardson BA, Lehman DA, Overbaugh J, John-Stewart GC (2005) Breast milk HIV-1 suppression and decreased transmission: a randomized trial comparing HIVNET 012 nevirapine versus short-course zidovudine. AIDS 19:1415–1422

    Article  PubMed  CAS  Google Scholar 

  25. Tonwe-Gold B, Ekouevi DK, Viho I et al (2007) Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach. PLoS Med 4:e257

    Article  PubMed  Google Scholar 

  26. Kumwenda NI, Hoover DR, Mofenson LM et al (2008) Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 359:119–129

    Article  PubMed  CAS  Google Scholar 

  27. Chasela CS, Hudgens MG, Jamieson DJ et al (2010) Maternal or infant antiretroviral drugs to reduce HIV-1 transmission. N Engl J Med 362:2271–2281

    Article  PubMed  CAS  Google Scholar 

  28. Kramer MS, Aboud F, Mironova E et al (2008) Breastfeeding and child cognitive development: new evidence from a large randomized trial. Arch Gen Psychiatry 65:578–584

    Article  PubMed  Google Scholar 

  29. Alioum A, Dabis F, Dequae-Merchadou L et al (2001) Estimating the efficacy of interventions to prevent mother-to-child transmission of HIV in breast-feeding populations: development of a consensus methodology. Stat Med 20:3539–3556

    Article  PubMed  CAS  Google Scholar 

  30. Thior I, Lockman S, Smeaton LM et al (2006) Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA 296:794–805

    Article  PubMed  CAS  Google Scholar 

  31. Kuhn L, Aldrovandi GM, Sinkala M et al (2008) Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med 359:130–141

    Article  PubMed  CAS  Google Scholar 

  32. Nduati R, Richardson BA, John G et al (2001) Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial. Lancet 357:1651–1655

    Article  PubMed  CAS  Google Scholar 

  33. Coutsoudis A, Coovadia H, Pillay K, Kuhn L (2001) Are HIV-infected women who breastfeed at increased risk of mortality? AIDS 15:653–655

    Article  PubMed  CAS  Google Scholar 

  34. Coutsoudis A, England K, Rollins N, Coovadia H, Newell ML, Bland R (2010) Women’s morbidity and mortality in the first 2 years after delivery according to HIV status. AIDS 24:2859–2866

    Article  PubMed  Google Scholar 

  35. Kuhn L, Kasonde P, Sinkala M et al (2005) Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia. AIDS 19:1677–1681

    Article  PubMed  Google Scholar 

  36. Otieno PA, Brown ER, Mbori-Ngacha DA et al (2007) HIV-1 disease progression in breast-feeding and formula-feeding mothers: a prospective 2-year comparison of T cell subsets, HIV-1 RNA levels, and mortality. J Infect Dis 195:220–229

    Article  PubMed  CAS  Google Scholar 

  37. Farmer PE, Nizeye B, Stulac S, Keshavjee S (2006) Structural violence and clinical medicine. PLoS Med 3:e449

    Article  PubMed  Google Scholar 

  38. Creek TL, Kim A, Lu L et al (2006) Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana. J Acquir Immune Defic Syndr 53:14–19

    Article  Google Scholar 

  39. Chopra M, Doherty T, Mehatru S, Tomlinson M (2009) Rapid assessment of infant feeding support to HIV-positive women accessing prevention of mother-to-child transmission services in Kenya, Malawi and Zambia. Public Health Nutr 12:2323–2328

    Article  PubMed  Google Scholar 

  40. Homsy J, Moore D, Barasa A et al (2010) Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-Infected women on highly active antiretroviral therapy in rural Uganda. J Acquir Immune Defic Syndr 53:28–35

    Article  PubMed  Google Scholar 

  41. Kafulafula G, Hoover DR, Taha TE et al (2010) Frequency of gastroenteritis and gastroenteritis-associated mortality with early weaning in HIV-1-uninfected children born to HIV-infected women in Malawi. J Acquir Immune Defic Syndr 53:6–13

    Article  PubMed  Google Scholar 

  42. Kuhn L, Aldrovandi GM (2009) Clean water helps but is not enough: challenges for safe replacement feeding of infants exposed to HIV. J Infect Dis 200:1183–1185

    Article  PubMed  Google Scholar 

  43. Phadke MA, Gadgil B, Bharucha KE et al (2003) Replacement-fed infants born to HIV-infected mothers in India have a high early postpartum rate of hospitalization. J Nutr 133:3153–3157

    PubMed  CAS  Google Scholar 

  44. Kagaayi J, Gray RH, Brahmbhatt H et al (2008) Survival of infants born to HIV-positive mothers, by feeding modality, in Rakai, Uganda. PLoS One 3:e3877

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Global Health, Medicine, Epidemiology and Pediatrics, University of Washington, Seattle, WA, USA

    Grace John-Stewart M.D., Ph.D.

  2. Department of Pediatrics, University of Nairobi, Nairobi, Kenya

    Ruth Nduati M.B.Ch.B., M.Med., M.P.H.

Authors
  1. Grace John-Stewart M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ruth Nduati M.B.Ch.B., M.Med., M.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Grace John-Stewart M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. School of Medicine, Emory University, Buford Highway 4770, Atlanta, 30341, Georgia, USA

    Athena P. Kourtis

  2. and Prevention, Global AIDS Program - China, Centers for Disease Control, Emory University School of Medicine, Beijing, 100600, China, People's Republic

    Marc Bulterys

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media New York

About this chapter

Cite this chapter

John-Stewart, G., Nduati, R. (2012). Should Women with HIV-1 Infection Breastfeed Their Infants? It Depends on the Setting. In: Kourtis, A., Bulterys, M. (eds) Human Immunodeficiency Virus type 1 (HIV-1) and Breastfeeding. Advances in Experimental Medicine and Biology, vol 743. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-2251-8_21

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-2251-8_21

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-2250-1

  • Online ISBN: 978-1-4614-2251-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation