It
is known that HIV may be transmitted from mothers to
babies via breast-feeding. In developed countries, HIV positive mothers are
advised not to breast-feed, but in resource-limited settings, breast-feeding
may be safer than formula-feeding if clean water is not readily available.
As
reported in the January 16, 2007 online edition of PLoS Medicine, researchers
with the ANRS 1201/1202 Ditrame Plus Study Group assessed the safety of breast-feeding
in Abidjan, Cote d'Ivoire. During the period 2001-2005, HIV positive pregnant
women who received antiretroviral prophylaxis around the time of delivery were
presented with 2 infant feeding alternatives: formula-feeding or short-term exclusive
breast-feeding through 4 months of age. Nutritional counseling and clinical management
were provided for 2 years, and formula was offered for free.
The
researchers collected data on the occurrence among infants of adverse health outcomes
(diarrhea, acute respiratory infections, malnutrition), hospitalization, or death.
The 18-month mortality rates were also compared to those observed in the earlier
Ditrame trial, conducted at the same sites in 1995-1998, in which women practiced
long-term breast-feeding in the absence of any specific infant feeding interventions.
Results
•
Out of
557 live-born children, 262 (47%) were breast-fed for a median of 4 months, whereas
295 were formula-fed.
•
Women
who chose to formula-feed were more educated, less likely to live in shared housing,
and more likely to have access to tap water in their homes compared with breast-feeding
mothers.
•
Over
the 2-year follow-up period, 37% of the formula-fed infants and 34% of the short-term
breast-fed children remained free of any adverse health outcomes (adjusted HR
1.10; P = 0.43).
•
Formula-fed
children were more likely to have diarrhea and acute respiratory infections, while
breast-fed children were more likely to develop malnutrition.
•
The
2-year probability of hospitalization or death was the same among formula-fed
(14%) and short-term breast-fed children (15%) (adjusted HR 1.19; P = 0.44).
•
The
overall 18-month probability of survival was 96% among both short-term breast-fed
and formula-fed HIV-uninfected children, which was similar to the 95% probability
observed in earlier Ditrame trial.
Conclusion
"The
2-year rates of adverse health outcomes were similar among short-term breast-fed
and formula-fed children," the authors concluded. "Mortality rates did
not differ significantly between these two groups and, after adjustment for pediatric
HIV status, were similar to those observed among long-term breast-fed children."
They
added that, "Given appropriate nutritional counseling and care, access to
clean water, and a supply of breast-milk substitutes, these alternatives to prolonged
breast-feeding can be safe interventions to prevent mother-to-child transmission
of HIV in urban African settings."
In a perspective article in the
same issue, Grace John-Stewart of the University of Washington at Seattle discussed
the current state of knowledge about the safety of alternative infant feeding
methods.
While
formula-feeding appeared as safe as short-term breast-feeding in this study --
and comparable to long-term breast-feeding in the previous Ditrame study -- she
noted that these findings could not necessarily be applied to other areas in sub-Saharan
Africa, or to "real world" settings that lack the close monitoring,
free formula, and support offered to trial participants.
It
is known that HIV may be transmitted from 
