March 2007 was an important month for high-profile research and
evidence that favoured breastfeeding in resource-poor settings and
called for a global re-assessment of policy surrounding safe
infant/child feeding and the prevention of postnatal paediatric HIV.
In Los Angeles, at the 14th Conference on Retroviruses and
Opportunistic Infections (CROI), several presentations and reports
addressed the dangers of formula feeding for HIV-exposed babies in
sub-Saharan Africa. HM Coovadia was quoted starkly juxtaposing risks
in saying “If you choose breastfeeding, you would of course have HIV
infection….About 300,000 per year in the world. But if you avoided
breastfeeding, the mortality would be about 1.5 million per year.
So, on the balance of probabilities for poor women in the developing
world, there is no other choice than to breastfeed their
In October 2006, for the first time in six years, the WHO revised
their recommendations for infant feeding and the prevention of
HIV(2). Many of the revisions were based
on evidence which was presented at the 14th CROI. Some important
- Increased cases of malnutrition and diarrhoea in
formula-fed infants in Botswana (3)
- A connection between rapid weaning and the increased risk
of hospitalization and death (4)
- From the Zambian Exclusive Breastfeeding Study - the
conclusion that programmes should encourage breastfeeding for
HIV infected infants (5)
Just days after the Conference closed, The Lancet
published a study organized in South Africa which tracked 1,372
HIV-infected mothers and found that exclusively breastfed infants
had a 4% postnatal transmission rate. This is one of the first
studies to accurately focus on exclusive vs. mixed feeding of
infants. In addition, the study showed that the death rate of
infants under 3 months who were exclusively breastfed was halved
from that of formula fed infants(6).
The presentation of these new findings offers hope that future
policy for prevention of postnatal paediatric HIV transmission may
be framed in a less reactive way and balanced with the important
promotion of breastfeeding. However, advocates for Maternal and
Child Health still face the complex challenges of redressing
communities that have adopted unsafe formula-feeding practices and
promoting the revised WHO recommendations so that they may be
effectively implemented to ensure the safest programmes for mothers
and children throughout the developing world.
Infant feeding policy debated at the 14 th CROI – AIDSMAP HATIP#82,
13 th March 2007.
(2)WHO HIV and Infant Feeding
Technical Consultation, Consensus Statement (Oct. 2006 in Geneva)
(3)Creek T, Arvelo W, Kim A, Lu L, Bowen A,
Finkbeiner T, Zaks L, Masunge J, Shaffer N and Davis M. Role of
Infant Feeding and HIV in a Severe Outbreak of Diarrhea and
Malnutrition amoung Young Children, Botswana, 2006, Poster session
137, 14 th CROI, Los Angeles 25-28 February, 2007.
(4)Ref: Thomas T, Masaba R, van Eijk A, Ndivo R,
Nasokho P, Thigpen M and Fowler M. Rates of Diarrhea Associated with
Early Weaning among Infants in Kisumu, Kenya, Poster Session 138, 14
th CROI, Los Angeles, 25-28 February
(5)Sinkala M, Kuhn L, Kankasa C, Kasonde P, Vwalika
C, Mwiya M, Scott N, Semrau K, Aldrovandi G, Thea D and Zambia
Exclusive Breastfeeding Study Group (ZEBS). No Benefit of Early
Cessation of Breastfeeding at 4 Months on HIV-free Survival of
Infants Born to HIV-Infected Mothers in Zambia : The Zambia
Exclusive Breastfeeding Study, Session 136, Poster Session, 14 th
CROI, Los Angeles 25-28 February, 2007.
(6)Coovadia HM, Rollins NC , Bland RM, et al.
Mother-to-child transmission of HIV-1 infection during exclusive
breastfeeding in the first 6 months of life: an intervention cohort
study. Lancet 2007; 369: 1107-16.