NIH press release from today.

Laura Mundt, ICCE
Portland, OR

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>Date:         Thu, 17 Jun 2004 17:19:22 -0400
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>Subject:      ANALYSIS SHOWS INFANTS OF MOTHERS INFECTED WITH HIV
>FACE NEARLY C
>               ONSTANT RISK FOR HIV INFECTION FOR DURATION OF BREASTFEEDING
>To: [log in to unmask]
>
>U.S. Department of Health and Human Services
>
>NATIONAL INSTITUTES OF HEALTH
>
>NIH News
>
>National Institute of Child Health and Human Development
>http://www.nichd.nih.gov
>
>FOR IMMEDIATE RELEASE
>Wednesday, June 16, 2004
>
>CONTACT:
>Robert Bock or
>Marianne Glass Miller
>301-496-5133
>
>
>ANALYSIS SHOWS INFANTS OF MOTHERS INFECTED WITH HIV FACE
>NEARLY CONSTANT RISK FOR HIV INFECTION FOR DURATION OF
>BREASTFEEDING
>
>PREVIOUSLY, RESEARCHERS THOUGHT RISK DIMINISHED AS INFANTS
>GREW OLDER
>
>After four weeks of age, infants who breast feed from
>mothers infected with HIV continue to be at risk for
>infection with HIV for as long as they breastfeed,
>according to an analysis conducted and funded by the
>National Institute of Child Health and Human Development of
>the National Institutes of Health.  Previously, researchers
>thought the risk for being infected with the virus from
>breast milk diminished as an infant grew older.
>
>The analysis determined that a significant proportion of
>infants -- 42 percent -- were infected by breast feeding
>after they were 4 weeks old.
>
>The study also found that infants were at greater risk for
>contracting the virus through breastfeeding if their
>mothers had low levels of CD4+ cells, an immune cell
>targeted by the AIDS virus.  Moreover, male infants were
>more likely to contract the virus through breastfeeding
>than were female infants.
>
>The analysis was conducted by NICHD and the Ghent Working
>Group on HIV in Women and Children, appears in the June 15
>issue of "The Journal of Infectious Diseases".
>
>"In many poor countries, mothers who are infected with HIV
>don't have the option of bottle feeding their infants to
>prevent spreading the virus to them," said Duane Alexander,
>M.D., Director of the NICHD.  "This information will help
>us to devise new ways to help prevent infants from becoming
>infected with the AIDS virus."
>
>In developed countries like the United States, mothers
>infected with HIV are generally advised not to breast feed
>their infants.
>
>The analysis pooled information from a number of studies
>that took place in Africa, said the NICHD author of the
>study, Jennifer Read, M.D., M.P.H., of NICHD's Pediatric
>Adolescent and Maternal AIDS Branch.  Dr. Read explained
>that one of the greatest strengths of the study was the
>large number of children included in the analysis.  Taken
>together, the number of children in the study was much
>larger than in any of the studies that attempted to address
>the issue previously.  All of the studies included in the
>larger analysis regularly assessed the infants' feeding
>patterns as well as their HIV infection status, beginning
>shortly after birth
>
>For the analysis, researchers examined information on 4,085
>children in 9 studies.  A total of 3,025 children in the
>study had negative HIV test results at 4 weeks of age and
>were breastfed through at least 28 days of age.  Of these
>3,025 children, 223 had late postnatal transmission --
>testing negative for HIV at 4 weeks of age, but testing
>positive after that time.  The remainder of the 3,025
>children who were uninfected at 4 weeks of age did not
>become infected.
>
>Late postnatal infections occurred throughout the duration
>of breastfeeding, with children becoming infected at any
>time, from when they were 4 weeks old until they were 18
>months old.  In all, late postnatal transmissions occurred
>among 42 percent of the 993 children for whom timing of HIV
>infection was known.
>
>The analysis also revealed that children of mothers who had
>low levels of CD4+ cells were more likely to become
>infected with HIV than were children whose mothers had
>higher CD4+ levels.
>
>"The association of lower maternal CD4+ counts and a higher
>risk of transmission was not unexpected," Dr. Read said.
>"Individuals with lower CD4+ counts may have higher
>concentrations of HIV in the bloodstream and in
>breastmilk."
>
>The researchers do not know why male infants were more
>likely to develop late postnatal infections than female
>infants were.  A possible explanation is that, due to
>gender differences in immune functioning, girls are less
>susceptible to the infection after 4 weeks of age than are
>boys.  The researchers wrote that other studies have found
>that the immune systems of infected male infants vary
>somewhat from the immune systems of infected female
>infants.
>
>According to Dr. Read, the study findings might be useful
>in devising new strategies to prevent infected mothers from
>passing HIV to their infants through breast milk.  Such
>strategies are essential, she said, as many women in poor
>countries don't have the option of formula feeding their
>infants.  In some areas, formula may be too expensive for
>women to afford.  Other areas may lack clean water, and
>mixing formula with local water may place infants at
>greater risk of contracting often times fatal diarrheal
>diseases.  In other areas, it may be socially unacceptable
>for women not to breast feed their infants.  In such areas,
>she explained, choosing not to breast feed -- or any other
>sign that a woman is infected with HIV -- may result in
>adverse consequences for the woman, such as being the
>victim of domestic violence.
>
>The researchers discussed possible strategies for
>preventing the virus from spreading through breast milk,
>such as giving anti-HIV drugs to mothers who are breast
>feeding.  Similarly, such drugs might be given to infants
>while they are breast feeding.
>
>"An important implication of our analyses is that, since
>children of HIV-1-infected mothers have a consistent and
>substantial risk of acquisition of HIV-1 throughout the
>period of breast-feeding, to be most effective,
>interventions to prevent transmission through breast-
>feeding should be continued until the cessation of breast-
>feeding," the researchers wrote.
>
>The NICHD is part of the National Institutes of Health
>(NIH), the biomedical research arm of the federal
>government. NIH is an agency of the U.S. Department of
>Health and Human Services. The NICHD sponsors research on
>development, before and after birth; maternal, child, and
>family health; reproductive biology and population issues;
>and medical rehabilitation. NICHD publications, as well as
>information about the Institute, are available from the
>NICHD Web site, http://www.nichd.nih.gov, or from the NICHD
>Information Resource Center, 1-800-370-2943; e-mail
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>
>##
>
>This NIH News Release is available online at:
>http://www.nih.gov/news/pr/jun2004/nichd-16.htm
>
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