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any babies infected by breast milk?
#46129 - 12/02/02 03:07 PM
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Would someone know how many if any babies hiv infected by breast milk?
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Lots. Though not sure if anyone is counting. In the developing world there is not much of choice...as there are no alternatives. In the US most reasonable women don't breastfeed if they are postive.
Study Finds HIV Breastfeeding Risk Highest in Early Months After Birth
NIAID News Release
National Institute of Allergy and Infectious Diseases
National Institutes of Health
August 24, 1999
An infant's risk of becoming infected with the AIDS virus through breastfeeding is highest during the first few months of life, according to a new study conducted among HIV-infected mothers and their babies in the African nation of Malawi. A mother's inexperience with breastfeeding may increase HIV transmission risk.
A report of the study by researchers from the National Institutes of Health, the Johns Hopkins School of Hygiene and Public Health in Baltimore, MD, and the Malawi College of Medicine in Blantyre, Malawi, appears in the August 25 issue of the Journal of the American Medical Association.
"This is a very important area of research," comments Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), which co-funded the study with the National Cancer Institute (NCI). "Little is known about the timing of HIV infection through breastfeeding or the associated risk factors. This finding and other ongoing studies will help HIV-infected women make informed decisions about infant feeding."
Breastfeeding is the recommended method of infant feeding in Malawi and other developing countries, where alternatives to breast milk are often scarce, unsafe or culturally unacceptable. In the United States, where safe alternatives to breast milk are plentiful, HIV-infected women are advised against breastfeeding their infants.
Lead author Paolo Miotti, M.D., of NIAID's Division of AIDS, senior author Robert J. Biggar, M.D., of NCI's Division of Cancer Epidemiology and Genetics, and their colleagues investigated the timing of, and risk factors for, HIV infection among breastfed infants of HIV-infected mothers. The researchers tested infants for HIV infection during visits to the postnatal care clinic of a large urban hospital in Malawi. Only babies who tested negative for HIV at their first visit, six weeks after birth, were included in the study. The researchers' objective was to examine breastfeeding-related HIV infections. Positive HIV tests during the first weeks of life can result from infection that occurred during pregnancy or childbirth as well as through breastfeeding.
Subsequent HIV tests conducted over the next two years revealed that 47 of the 672 infants in the study became HIV-infected from breastfeeding. Nearly half (21) of the infections occurred within five months after birth. Another 15 babies became infected between postnatal months 6 and 11, and seven more between months 12 and 17 of follow-up. Only four HIV infections occurred between months 18 and 23. No babies became infected with HIV after they stopped breastfeeding.
Statistical analyses showed that women who had fewer than four previous births were more likely to transmit HIV through breast milk than were women who had four or more. Similarly, younger mothers were more likely than older mothers to transmit HIV through breast milk.
Drs. Miotti, Biggar and their colleagues speculate that mothers who are relatively less experienced with breastfeeding are more likely to have subclinical mastitis, an inflammation of the mammary tissue, and thereby a higher HIV transmission rate. The researchers note that in another recent study conducted among a separate population of women in Malawi, they found that subclinical mastitis was associated with higher HIV levels in breast milk and higher HIV transmission to breastfeeding infants.
"HIV transmission was highest in the early months, but persisted for as long as infants continued breastfeeding," notes Dr. Miotti. "Early weaning has been proposed as one possible strategy to limit HIV transmission through breast milk," he adds. "Although discontinuing breastfeeding after six months would have prevented half of the HIV infections seen in our study, such an approach would increase the risk for illness and death from the respiratory and diarrheal diseases that antibodies and other factors in breast milk help protect against."
The researchers conclude that breastfeeding recommendations for HIV-infected women in developing countries must carefully balance the risk of HIV transmission with the well-known nutritional and health benefits of breastfeeding. "Recommendations may be most usefully made at the level of the individual mother, since communities in developing countries include women from varied socioeconomic strata who have different access to safe-milk alternatives."
Reference:
PG Miotti, TET Taha, NI Kumwenda, et al. HIV transmission through breastfeeding: a study in Malawi. JAMA 282:744-49 (1999).
NCI and NIAID are components of the National Institutes of Health (NIH). NCI is the principal federal agency working to prevent cancer and help patients live longer and healthier lives. NIAID conducts and supports research to prevent, diagnose and treat illnesses such as HIV disease and other sexually transmitted diseases, tuberculosis, malaria, asthma and allergies. NIH is an agency of the U.S. Department of Health and Human Services.
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I see there is little hiv in breast milk, but mastitis a very common condition with engorged breasts...produces higher rates of hiv virus, so infecting the babies.
No one should ever ever take a chance with breast feeding your baby, it is not worth your baby's life is it! Would be a horrible thing to live with, knowing your baby got infected through your breast milk.
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Breast milk is a MAJOR mode of transmission. If you suspect you have HIV get tested and do not breast feed.
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It's a problem particularly in the developing world...In the U.S. most pregnant women are tested and use formula if they have HIV.
Hiv+ Mums Puzzled About Breastfeeding
From New Vision Magazine (Kampala)
December 3, 2002
Gerald Businge
Kampala
Juliet Nakalema, (not real name), gave birth to a bouncing baby boy a week ago. She is HIV positive and is determined to save her child from contracting the virus. She says that is why she joined the Prevention of Mother to Child Transmission (PMTCT) programme at Mulago Hospital.
Nakalema was given free Nevirapine (NVP). It is an anti retroviral drug which she took at the beginning her 36th week in pregnancy. The doctors said her child should also take 2mg of NVP syrup after six days of life. This would increase chances of the baby's survival by over 50%.
What Nakalema went through is part of the PMTCT package recommended by doctors. Now Nakalema is being told she should breastfeed for only three months. That is if, she can't forego breastfeeding at all. How will she handle this in our society that traditionally believes in breastfeeding for the better health of babies, and scientifically so?
This was one of the challenges discussed in a recent workshop on PMTCT held at Entebbe Botanical Beach Hotel from November 12-15. Policy makers and health care providers from the districts of Kampala, Mukono, Mpigi, Wakiso and Mubende participated in the three-day workshop organised by Mulago hospital based on Makerere University John Hopkins Research collaboration (MU-JHU).
In the first year of life, breastfeeding has been proved to be the best for babies. Prof. Francis Miiro of the Mulago PMTCT programme told participants that breastfeeding is the normal infant feeding practice in Uganda as elsewhere. However, it is possible for a breastfeeding HIV positive mother to pass on the various to the baby through the breast milk.
"Breastfeeding contains appropriate nutrients for the infant in a well balanced and suitable form. It is ideal but in the face of HIV, we have to give mothers the information on the infant feeding options so that they make an informed choice," Prof. Miiro said.
"If an HIV positive mother chooses to breastfeed her baby, she should be supported to exclusively breastfeed for a period not exceeding six months, preferably three. This is because the risks of transmission increase with a prolonged breastfeeding period," said Dr. Philippa Musoke of MU-JHU research collaboration.
But even then, mothers should be advised on how to do it safely. The ministry highly recommends exclusive breastfeeding - giving only breast milk to the baby, especially for HIV positive mothers. This is especially for those who are not able to use replacement feeding. But the ministry acknowledges this is not an easy option.
Replacement feeding refers to giving the baby nutritious diet like animal milk, commercial infant formula, generic formula is recommended, but it is expensive for most women in Uganda.
"Even organisations like Unicef who had started programmes of giving mothers replacement feeds have stopped. This leaves mothers and the babies yearning. The only option is putting the baby back on breast milk," said Joyce Matovu, the Coordinator of the PMCT counselling at Mulago hospital.
Custom and religion continue to play a negative role concerning the right of women to good sexual health and choice.
Participants of the Women's Worlds Congress held at Makerere University in July this year, expressed concern that prevention of mother to child transmission of HIV as an intervention programme in the fight against HIV, may not be helpful, if implemented in isolation.
They noted that even when women learn about the free drugs to prevent mother-to-child transmission, they have to consult their husbands. There is fear of losing a spouse.
"Once women give birth especially in our African societies, they have to be seen to be breastfeeding. If they don't, everybody will know they have a problem. With our cultures, how can an HIV positive mother abstain from breastfeeding?" a participant asked.
Prof. Miiro told participants to encourage all pregnant women to go for antenatal care and counselling. "The PMTCT package includes quality antenatal, intranatal and postnatal care. There is need for provision of free anti-retroviral drugs and voluntary and confidential counselling and testing for HIV," he said.
Participants observed that there is need for spouse and community involvement, counselling on safer sex, community education and mobilisation, if PMTCT is to be fruitful. But there are changes the doctors said are bound to meet permanent resistance.
"Boiling breast milk reduces HIV transmission, but society is unlikely to accept it despite the supportive studies, " Prof. Miiro lamented.
Even expressing breast milk for the baby - the inevitable option of working mothers who want to ensure their babies get breast milk, is met with resounding stigma in some circles.
"Some people in the villages ask how a woman can be milked like a cow. But breast milk is the best you can give to the baby. And you are assured no housegirl will ever tamper with breast milk. The baby will get it all," Matovu said.
What about wet-nursing, one of the options HIV positive mothers are being advised to take up? This requires the mother getting an HIV negative woman to breastfeed her baby. "This too is not easy for some mothers. Some husbands and especially mothers-in-laws say their babies can't be breastfed by another woman."
Mothers were strongly advised against mixed breastfeeding. "Mothers should desist from giving their babies water, tea, milk, dilute cereal and juices on top of breast milk. This type of feeding is very dangerous to babies as it may cause diarrhoea and damage the stomach and intestines making it easier for the virus to enter the baby's body from the infected mother's milk," said Jane Nabalonze from the Ministry of Health.
MU-JHU is organising regional workshops to sensitise people about PMTCT and to have it integrated in the local government's health care systems by the districts.
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