Feeding Infants HIV- Positive Mother

The current WHO recommendations on feeding infants of HIV-positive women are replacement  feeding when this is acceptable, feasible, affordable, sustainable and safe, with home- prepared formula or commercial formula; or exclusive breast feeding (EBF) for the first few months of life and cessation of breast feeding as early as possible.

 The risk of intrauterine and intrapantum mother- to – child transmission (MTCT) of HIV in term newborn infants, who are born to  mothers who are known to be HIV-positive and who have not taken antihero viral (ARV)medication, has been described as 20-30%.The risk of MTCT through human milk in term newborn in founts, born to mothers who are known to be HIV- positive and who have not taken ARV medication, is 10- 15%.

 The risk of delivering a low birth weight (LBW) infant is higher in HIV- positive women them I HIV-negative women. The risk of MTCT through human milk may be higher in LBW than non- LBW infants as the mother have additional risk factors for trans mission (e.g.a sexually transmitted infection, mastitis or cracked nipples). Among infants born to HIV-positive mothers, there is a twofold hanger risk of becoming HIV- infected during intrapartum and earl breastfeeding precook in pre- term infants that in infants horn after 37 weeks. The risks of infection from replacement feeding are also likely to be higher in LBW than non- LBW infants as the forms have a higher risk of impaired immunity and of infection.

HIV-infected mother of LBW infants may not know their HIV stats at the time of birth, especially if this is earthier than expected. Further, even if the mother knows her HIV status, she may not have received HIV and infant feeding counseling.

 Lets review for published studies on the following issues:
  • Choice of milk in infants born to HIV-positive mother.
  • Counseling on infant feeding for HIV-positive mother of LBW infants. Effects  on Mortality, neuro development and malnutrition

 So for, no studies are available which examines the inpact of choice of milk or counseling on HIV and infant feeding on mortality rates, severe nombichit, new development and malnutrition/ growth in LBW infants born to HIV-positive mothers.

 Effects on serious morbidity- HIV transmission

There is evidence from observational studies in south. Africa that the risk of HIV transmission is lower if infants are on EBF using good technique, compared with mixed feeding, in the first few months of life. A    A  recent study from Zimbabwe supports this observation. HIV transmission rates/100 child-years at 6 months were 5.1 for exclusive breastfeeding, 6.7 for predominant breastfeeding, and 10.5 for mixed feeding. There are on data on the risks of HIV transmission in infants who moved from formula/ Mixed feeding to EBF early in life.

ON data were available that examined the impacts of heat treatment of mother’s own milk in HIV- positive mothers of LBW infants. In non LBW infants, heat treatment by flash and prtoria pasteurization methods inactivated HIV. Significantly and eliminate bacterial contaminants. Neither method was reported to canse significant decrease in any vitamin, lacto ferrying or lysozyme. These methods could be implemented by a mothers in a developing country but studies have shown that acceptability is variable.

 Recommendations:

  • We should help the mother to assess her situation and decide which is best option for her, and support her choice.
  • We should make sure she understands that if she chooses replacement feeding up to 2 years. If this can’t be ensured, exclusive breast feeding, stopping early when replacement feeding is feasible is an alternative. And all babies receiving replacement feeding need regular follow-up, and their mothers need support to provide correct replacement feeding.
  • The risk of not breast feeding may be much higher becomes replacement feeding may causes diarrhea because of contamination from unclean water, unclean utensils or because milk is left out too long. Besides, this is a risk of malnutrition because of insufficient quality given to the body, the milk is too watery, or because of recurrent episodes of diarrhea.
  • Mixed feeding should be discouraged as it increases the risk of diarrhea.  It may also increase the risk of HIV transmission.

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