Listen (1.7MB MP3, 4 min.)

As CROI 2007 drew to a close, we asked Wayne Duffus, M.D., to discuss what he felt was the most interesting research presented at the conference. Dr. Duffus is the medical director for the HIV/STD Division of the South Carolina Department of Health and Environmental Control and a practicing clinician at the University of South Carolina School of Medicine.

Well, I liked the studies pertaining to breastfeeding, particularly in the countries where there is high HIV prevalence. [Read the abstracts of studies by Onyango et al, Coovadia et al, Atashili et al and Sinkala et al.] The recommendation has always been, if you're HIV [infected], not to breastfeed, because it represents about [a] 30% to 50% chance of transmission to your child. That's a first-world policy to a third-world country. So we have to think about what ... that means. ...

"The breast is best" is always a policy that we've used. [As] for recommending otherwise, it turns out that there are higher mortalities associated with formula-fed infants, as opposed to breastfed infants. That was a big surprise to me, even though there were some data [suggesting] that previously, but we've gathered more evidence for that.

As it turns out, if moms formula feed, they might decrease the risk of transmitting HIV to their infants. However, there's increased mortality from diarrhea and malnutrition overall. We find that the risk of transmitting, of course, is greater if the mom has a very low CD4+ [cell] count, as opposed to a higher CD4+ [cell] count, and that exclusive breastfeeding is associated with a lower risk of transmission.

I'm sorry. "Exclusive?"

Exclusive breastfeeding: That's [when] mom breastfeeds only, as opposed to someone who does partial breastfeeding, where water or fruit juices, and so on, [are] mixed in. I'm not quite sure I understand what the pathology is, and I believe it has to do with [the fact that] maybe a disruption of the membrane of the intestine allows access of the virus through.

So, yes, babies will be born HIV infected if you breastfeed, but there are more children who will die from malnutrition and diarrhea than those that will die from being HIV infected. [This] is hard for us to put our brain around, but the numbers are quite staggering. I'm trying to recollect the numbers. If I were to make it up, it would be 30 kids who would acquire HIV, as opposed to 3,000 that would die from malnutrition and diarrhea. The contrast is really dramatic. You have to wonder if our policy that says "don't breastfeed" is really a good thing to do. I know Dr. Tracy Creek did a study in Botswana ... where the government issued a policy of not breastfeeding, the rate of malnutrition and diarrhea just skyrocketed, and so many children were dying -- more than were dying from HIV.

I think we have to go back to the drawing board to think what else we should be saying. Maybe exclusive breastfeeding, breastfeeding only and nothing else -- at least for the first six months of the kid's life -- is probably a better policy.

At least in the developing world.

At least in the developing world, yes. At least in the developing world. I think for the developed world, where we have clean drinking water and access to medical care and so on, and less infectious diseases associated with GI [gastrointestinal] illnesses, then that's a good strategy. But in the developing world, it's probably not. To me, that was a pretty striking finding at this conference.

To read or listen to more interviews with HIV clinicians about what they felt was the most important research presented at CROI 2007, click here.