From The Guardian -- seious UK daily paper Breastfeeding may guard against HIV Sarah Boseley, health editor Guardian Friday December 1, 2000 Breastfeeding may be the best way for mothers who are HIV positive to safeguard their babies from the infection, especially in the developing world, according to scientists whose work suggests that the conventional wisdom is badly flawed. Virtually all women in the west who are HIV positive give their babies bottled formula milk, which experts have maintained is the best way to protect them from becoming infected with the virus. But this advice, backed by the World Health Organisation, has been hard to follow for women in developing countries, who may not be able to afford formula milk and who risk revealing their HIV status to the entire community if they do not breastfeed. Most worryingly, the shortage of clean water in many areas means that bottles can give babies other serious infections. Pilot studies by a well-respected South African paediatrician, Jerry Coovadia, and his colleague, Anna Coutsoudis, show that women who exclusively breastfeed their babies run little or no risk of transmitting HIV to them. Their work, in a rural area of KwaZulu Natal, two hours from Durban, where only 5% have clean water and where cholera outbreaks are common, shows that exclusive breastfeeding is as safe as exclusive bottle feeding in terms of HIV transmission, and that considered in the context of the general health of the babies, it is better for them. A three-year project involving 2,000 women is likely to be launched next year, funded by the Wellcome Trust, to settle a fraught issue that is vital for the future of HIV/Aids management in the developing world. "If more extensive research proves that exclusive breastfeeding is no more risky than formula feeding, this has profound implications for preventing the spread of HIV in Africa and the developing world," said Prof Coovadia. "As well as the many advantages of exclusive breastfeeding - its cultural appropriateness, simplicity and well-documented health benefits - another major plus is that breast milk is free." His work has shown that the least safe method of feeding is the one most often practised in Africa - mixed breast and formula feeding. The scientists believe that contaminated water in the bottles may damage the baby's gut, allowing any HIV virus in the milk, which might pass through harmlessly, to enter the infant's system. The scientists published an early report of their findings in the Lancet last year. Their as yet unpublished follow-up of the children at 15 months old shows that the exclusively breastfed babies continue to thrive and are HIV free. "It is a unique observation by Coovadia and Coutsoudis that if you exclusively breastfeed, with no additional feeds including water, you have minimal or no risk of transmitting HIV," said Michael Bennish, director of the Wellcome Trust's Africa centre, where the study is based. "Not everyone accepts that." If breastfeeding is found to be the safest option for the developing world, one of the last objections to the use of drugs like nevirapine to prevent mothers transmitting the HIV virus to their babies during childbirth will have been removed. It has been argued that there is no point giving women and their infants the tablets, which are cheap and in some places have been donated free, because the babies will inevitably be infected through their mothers' milk unless an expensive programme to provide formula and clean water can be put in place as well. *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html