Findings Provide Insights into Breastfeeding in Preventing Infant Death, HIV Infection in Poor Countries
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Brief Description:
Two recent studies offer insights into preventing early death and HIV among breastfeeding infants of mothers with the virus in poor countries.
Transcript:
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.
National Institutes of Health (NIH)
Department of Health
