Mary

I just saw your further post on how to prevent Hep C through breastfeeding,
the possible connection that partial formula-feeding may damage the infant
gut and the similarities with research on HIV and breastfeeding.



I've been studying breastfeeding in the context of HIV for over 20 years,
and there is some quite compelling research showing that exclusive
breastfeeding is protective and/or that mixed feeding increases the risk of
transmission (1), and it sounds as if this is the info you might have heard
about.



The mechanisms are:

·       Increased risk of transmission of the HIV as a result of damage to
the infant gut due to exposure to foreign pathogens in other foods and
liquids  (solid foods may pose a 4-10 fold greater hazard than liquids) (2,
3).

·       Inflammation within the infant gut due to the introduction of
foreign antigens (4)

·       Elevations in breast milk viral load as a result of decreased
frequency of infant suckling and consequent mik stasis (breast engorgement
(5)

·       Epithelial permeability or increase in leaky tight junctions in the
breast, allowing more efficient paracellular transfer of cell-free and
cell-associated HIV (6)

·       Irregular vs regular milk removal (eg occasional long intervals
between breastfeeds, or shifts in breastfeeding frequency, leading to
elevated viral load in breastmilk (4)

·       Infrequent breastfeeding may also result in elevated breast milk
sodium, and/or subsequent mastitis, also known to be a risk factor for HIV
transmission (7)



There are also maternal pathological conditions which in theory can
increase the risk of transmission, and these should be prevented and/or
treated promptly:

·       Inflamed/infected breasts (mastitis, abscess) more likely with
mixed feeding (8)

·       Bacterial or fungal nipple infection (9)

·       Painful/damaged nipples (9)



I hope this helps.  You’re welcome to email me privately if you would like
to discuss this more.  I also have a nice diagram simplifying the perfect
storm which can happen when a foreign pathogen damages the infant
intestinal mucosa to enter the bloodstream making infection with the virus
more likely.



Refs:

1. Kuhn L, Sinkala M, Kankasa C, Semrau K, Kasonde P, Scott N, Mwiya M,
Cheswa V, Walter J, Wei-Yann T, Aldrovandi GM, and Thea DM.  High Uptake of
Exclusive Breastfeeding and Reduced Early Post-Natal HIV Transmission. PLoS
ONE Dec 2007; 2(12): e1363. doi:10.1371/journal.pone.0001363

2. Lunney KM, Iliff P, Mutasa K, Ntozini R, Magder LS, Moulton LH and
Humphrey JH. Associations between Breast Milk Viral Load, Mastitis,
Exclusive Breast-Feeding, and Postnatal Transmission of HIV Clinical
Infectious Diseases 2010; 50:762–769

3. Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML,
Newell M-L.  Mother-to-child transmission of HIV-1 infection during
exclusive breastfeeding in the first 6 months of life: an intervention
cohort study. Lancet 2007 March 31;369:1107-16

4. Smith MM, Kuhn L. Exclusive breast-feeding: does it have the potential
to reduce breast-feeding transmission of HIV-1? Nutr Rev 2000; 58:333–340.

5.  Kuhn L, Kim H-Y, Walter J, Thea DM, Sinkala M, Mwiya M, Kankasa C,
Decker D, Aldrovandi GM, HIV-1 Concentrations in Human Breast Milk Before
and After Weaning, Sci Transl Med  Vol. 5, Issue 181, p. 181ra51, Sci.
Transl. Med. DOI: 10.1126/scitranslmed.3005113, Apr 2013, see
http://stm.sciencemag.org/content/5/181/181ra51.full.html

6. Kourtis AP, Butera S, Ibegbu C, Belec L and Duerr A. Breast milk and
HIV-1: vector of transmission or vehicle of protection? Lancet Infect Dis 2003;
3: 786–93

7. . Semba RD, Kumwenda N, Taha TE, Hoover DR, Quinn TC, Yin Lan,
Mtimavalye L, Broadhead R, Miotti PG, van der Hoeven L and Chiphangwi JD,
Mastitis and immunological factors in breast milk of human immunodeficiency
virus-infected women. J Hum Lact 1999

8. Willumsen JF, Filteau SM, Coutsoudis A, et al. Breastmilk RNA viral load
in HIV-infected South African women: effects of subclinical mastitis and
infant feeding. AIDS 2003; 17:407–414

9. Semrau K, Kuhn L, Brooks DR, Cabral H, Sinkala M, Kankasa C, Thea DM,
Aldrovandi GM. Exclusive breastfeeding, maternal HIV disease, and the risk
of clinical breast pathology in HIV-infected, breastfeeding women. Am J
Obstet Gynecol. 2011 Oct;205(4):344.e1-8. Epub 2011 Jun 15.



Pamela Morrison IBCLC

Rustington, West Sussex, England

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