Thank you Magda, for the clarification on the Coutsoudis study. This is
important information. I agree that we have to see the effects of EBF for
more than 3 months on transmission.
What is a bit complicating in the Coutsoudis study (and it pointed out) is
the fact that the randomisation was on the basis of vitamin A
supplementation and not on feeding mode. This means that there was
self-selection into feeding category and makes the interpretation a bit
complex. FOr example, could it be that the HIV positive mothers who were in
better state of health chose to breasfeed exclusively whilst the others who
were worse off chose the other options and hence the findings? It would not
be possible to randomise feeding option, neither ethically or practically,
so how does one come around this?
Monitoring the health and nutrition status of the mothers would provide some
background information, that could be used for examining confounders in this
respect. Any more suggestions?
Amal

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