Very interesting article in the Lancet today about the risk of HIV
transmission in relation to infant feeding method.

"Influence of infant-feeding patterns on early mother-to-child
transmission of HIV-1 in Durban, South Africa: a prospective cohort
study, by Anna Coutsoudis et al

The proportions of HIV-1-infected infants at 3 months (estimated by use
of Kaplan-Meier life tables) were compared in the three different
feeding groups (exclusive breastfeeding, mixed feeding (breast/formula)
and formula).
After adjustment for potential confounders (maternal CD4-cell/CD8-cell
ratio, syphilis screening test results, and preterm delivery), exclusive
breastfeeding carried a significantly lower risk of HIV-1 transmission
than mixed feeding (hazard ratio 0·52 [0·28-0·98]) and a similar risk to
no breastfeeding (0·85 [0·51-1·42]).

From the conclusion:
"We used an early endpoint because early weaning is thought to
retain the benefits of breastfeeding while lowering the risk of
HIV-1 transmission. Models have estimated that the best time for
early weaning is 3 months.20 A possible recommendation is for
exclusive breastfeeding with early weaning. In addition, the benefits
of breastfeeding are particularly important in the first 3 months of
life. Finally, there is an urgent need to supplement existing
inadequate data on HIV-1 transmission through breastfeeding. Our
data can strengthen current UNAIDS policies on HIV-1 and
breastfeeding without requiring any policy changes because
exclusive breastfeeding is the existing recommendation for all
women. All that is required is a change in emphasis. "

Josefine (Jose) Wendel, MS, RD
Cambridge, MA

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