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Subject:
From:
Sarah Berreth <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 13 Feb 2001 16:40:38 -0600
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Since the discovery that HIV-1 can be transmitted through
breastfeeding, questions have been raised about whether the risk of
transmission of HIV-1 out ways the protective factors provided to the
infant through breast milk.  A study on the influence of infant feeding
patterns of the transmission of HIV-1, performed by Coutsoudis, Pillay,
Spooner, Kuhn, & Coovadia, found that mothers who chose to breastfeed
exclusively as well as those who avoided breastfeeding all together had
significantly lower transmission rates than those who chose mixed
feeding (1999).  Those who practiced exclusive breastfeeding had a
slightly lower transmission rate than those who avoided breastfeeding,
but the difference was not significant three months following birth.
   It has been shown that exclusive breastfeeding reduces the incidence
of otitis media, and diarrheal and respiratory disease morbidity and
mortality (Duncan, Ey, Holberg, Wright, Martinez, & Taussig, 1993;
Popkin, Adair, Akin, Black, Briscoe, & Flieger, 1990; Cesar, Cesar,
Barrow, Santos, & Flores, 1999).  It is believed that the same
protective mechanisms gained from exclusive breastfeeding that help
prevent diarrheal diseases may also help prevent the transmission of
HIV-1.  Some of these protective mechanisms include; facilitating
enterocyte junction closure of the intestinal mucosal barrier by
decreasing the amount of exposure to dietary antigens and environmental
pathogens, preventing intestinal irritation and inflammation that may be
caused by early introduction of mixed feeding providing a possible open
route for HIV-1 transmission, preventing common infectious
microorganisms form forming gin the intestinal microflora because of the
decreased buffering ability of breast milk which lowers intestinal pH,
favoring the growth of anaerobic lactobacilli and the known immunologic
protective mechanisms may also play a proactive role in preventing the
transmission of HIV-1 from mother-to-child (Smith & Kuhn, 2000).
   With proper attachment of the infant and frequent emptying of the
breasts, exclusive breastfeeding may also prevent cracked nipples,
engorgement, and mastitis, which may also be risk factors for
transmission of HIV-1 (Coutsioudis, 2000). With further research
exclusive breastfeeding may prove to be an effective and economical way
to reduce the rate of mother-to-child transmission of HIV-1.

Sarah Berreth, Student Nurse
University of North Dakota
Reference
   Cesar, J. A., Cesar, G. V., Barrow, C. F., Santos, I. S., & Flores,
J. A. (1999). Impact of breastfeeding on admission for pneumonia during
postneonatal period in Brazil: Nested case-control study. British
Medical Journal, 318, 1316-1320.
   Coutsoudis, A. (2000). Promotion of exclusive breastfeeding in the
face of the HIV pandemic. The Lancet, 356, 1620-1621.
   Coutsoudis, A., Pillay, K., Spooner, E., Kuhn, L., & Coovadia, H. M.
(1999). Influence of infant-feeding patterns on early mother-to-child
transmission of HIV-1 in Durban, South Africa: A prospective cohort
study. The Lancet, 354, 471-476.
   Duncan, B., Ey, J., Holberg, C. J., Wright, A. L., Martinez, F. D., &
Taussig, L. M. (1993). Exclusive breastfeeding for at least four months
protects against otitis media. Pediatrics, 91, 867-872.
   Popkin, B. M., Adair, L., Akin, J. S., Black, R., Briscoe, J., &
Flieger, W. (1990). Breastfeeding and diarrheal morbidity. Pediatrics,
86, 874-882.
   Smith, M. M., & Kuhn, L. (2000). Exclusive breastfeeding: Does it
have the potential to reduce breastfeeding transmission of HIV-1?
Nutrition Reviews, 58, 333-340.

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