Findings Provide Insights into Breastfeeding in Preventing Infant Death, HIV Infection in Poor Countries
Two recent studies offer insights into preventing early death and HIV among breastfeeding infants of mothers with the virus in poor countries.
Akinso: Two recent studies offer insights into preventing early death and HIV among breastfeeding infants of mothers with the virus in poor countries. Dr. Lynne Mofenson, is Chief of the Eunice Kennedy Shriver National Institute of Child Health and Human Development's Pediatric, Adolescent and Maternal AIDS Branch, and the project offer for the two studies. She describes the first study.
Mofenson: The Zambia exclusive breastfeeding study enrolled 958 women who were HIV infected and their infants and randomly assigned them to two groups. In the intervention group, women were counseled to exclusively breastfeed their infants for four months not offering any formula or other liquids and then to abruptly discontinue all breastfeeding when their infants were four months old. With the thought here being that you could provide protection during a very high risk group by allowing early breastfeeding and then you would avoid the risk of HIV transmission by stopping. The women were provided with formula and instructed how to safely prepare it. And in the control group the women were advised to exclusively breastfeed for four months and then to continue breastfeeding for as long as they chose to. And then the infants were tested for HIV infection periodically throughout the study and also mortality was evaluated.
Akinso: The study found no benefit for infants when their mothers with HIV stopped breastfeeding after the first four months. In addition, the study found no difference in HIV infection rates or in death rates by age 2 among infants abruptly weaned off all breast milk at four months versus those who breast fed until later in infancy. Dr. Mofenson talks about the second study.
Mofenson: This study was conducted in Malawi. This study enrolled a little over 3,000 infants who were born to HIV infected mothers but were not infected themselves at birth and compared two extended regiments of nevirapine to the country standard treatment. And the standard treatment in this country for women who do not present until labor or are identified as infected immediately postpartum is to give a single dose of nevirapine to the mother during labor and a single dose of nevirapine to the infant at birth and then daily doses of zidovudine to the infant for the first week of life. So that's the standard for this situation of late presenting women.
Akinso: The infants were assigned at random to one of three groups. The control group received the standard treatment. The next group received the standard treatment plus nevirapine day 8 through the 14th week of life. The final group received the standard treatment plus nevirapine and zidovudine. Dr. Mofenson concluded that providing anti-HIV drugs to breastfeeding infants is the way to go.
Mofenson: So this study showed that if you give 14 weeks of extended antiretroviral drugs to the baby you can reduce the risk of HIV transmission through breast milk.
Akinso: Dr. Mofenson added that in many poor countries mothers with HIV face a stark choice: to nurse their infants, and risk passing on HIV through their breast milk or to formula feed, and deprive their infants of much of the natural immunity needed to protect against fatal diseases of early infancy. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
About This Audio Report
Reporter: Wally Akinso
Sound Bite: Dr. Lynne Mofenson
Topic: HIV, Breastfeeding in Poor Countries