Cathy & Morgan

Responding now to Cathy's answer, actually there is one fairly recent 
study which showed, amazingly, that the rate of cumulative and 
postpartum transmission of HIV was higher for formula-fed babies than 
for exclusively breastfed babies.

In the DREAM study women received HAART from the 25th week of 
gestation, and their infants received post-exposure prophylaxis. At 
age 1 month, HIV-1 transmission rates were 1.2% among breastfed 
infants and 0.8% among formula-fed infants.  The cumulative incidence 
rate at 6 months of age was 2.7% for formula-fed infants and 2.2% for 
breastfed infants, with the postpartum transmission rate at age 6 
months, being 0.8% among breastfed infants of women receiving HAART 
and 1.8% among formula-fed infants.There was a trend for HIV 
infection rates to be slightly greater among formula-fed infants, but 
overall mother-to-child transmission rates in both cohorts were 
extremely low.   It was concluded that these results were comparable 
to those from developed countries (just under 2%).  Breastfeeding 
among HIV infected mothers receiving HAART posed no additional risk 
of late postnatal HIV transmission to the infant by 6 months of age. 
The authors did say that implementation of the strategy of 
formula-feeding was very difficult because of cost and "reliability" 
(the formula-feeding women will often mix breast and formula-feeding) 
and noted that formula-feeding was probably less effective for this 
reason when formula was available.  The authors conclude that 
provision of HAART was achievable in this very resource-poor setting, 
and for the same cost as provision of formula. A landmark study!

Ref:  Palombi L, Marazzi MC, Voetberg A, Magid NA. Treatment 
acceleration program and the experience of the DREAM program in 
prevention of mother-to-child transmission of HIV. AIDS. 2007 Jul;21 
Suppl 4:S65-71.

Pamela
Co-coordinator, WABA Breastfeeding and HIV Task Force.

------------------------------

Date:    Sun, 2 Dec 2007 11:08:20 -0600
From:    Cathy Liles <[log in to unmask]>
Subject: HIV & breastfeeding babies

   Hi Morgan,
I am not familiar with any studies that show HIV transmission is higher with
formula-fed babies. There is evidence that mortality is higher. There is
also growing evidence that EXCLUSIVE breastfeeding transmission rates are
about the same as replacement milk fed babies through at least 6 months. If
you are interested in this issue, check out AnotherLook at Breastfeeding and
HIV/AIDS  www.anotherlook.org
Cathy Liles

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