This document discusses breastfeeding and HIV infection. It notes that approximately one-third of infants born to HIV-positive mothers contract HIV, often through breastfeeding. The risks of HIV transmission through breastfeeding can be decreased by shorter duration of breastfeeding (6 months has a lower risk than 2 years), exclusive breastfeeding for the first few months, and preventing and treating breast problems. However, for HIV-infected mothers in developing countries, not breastfeeding increases the risk of other infectious diseases in infants. The decision to breastfeed or use breastmilk substitutes presents difficulties for these mothers.

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Breast Feeding and HIV Infection
FAUZIA JAWAID KAZI, Assistant Professor, KGMU-Institute of Medical Sciences,
Lucknow India.
Abstract:Approximately one-third of
infants born to HIV-positive mothers
contract HIV through mother-to-child
transmission, becoming infected during
their mothers' pregnancy, childbirth or
breastfeeding without preventive
interventions. In 2001, 800,000 children
under the age of 15 contracted HIV, over
90 per cent of them through mother-to-
child transmission of HIV (MTCT).
Between 15 and 25% of children born to
HIV-infected mothers get infected with
HIV during pregnancy or delivery, while
about 15% of the children get infected
through breastfeeding.
Factors that may decrease the risk of
HIV transmission through breastfeeding
include:
Shorter duration of
breastfeeding. The longer a child
is breastfed by an HIV-positive
mother the higher the risk of HIV
infection. Breastfeeding for 6
months has about one third of the
risk of breastfeeding for 2 years.
Exclusive breastfeeding in the
early months. Some
immunological studies are finding
that there are factors in human
milk, especially the milk of the the

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HIV-infected mother, that will
directly combat the cells that
contribute to the transmission of
the HIV infection. A study done in
Durban, South Africa showed that
exclusive breastfeeding during the
first 3 months of life resulted in a
lower risk of MTCT than mixed
feeding (breastfeeding combined
with other foods, juices or water)
Prevention and treatment of
breast problems. Mastitis and
cracked nipples and other causes
of breast inflammation are
associated with an increased risk
of HIV-transmission.
Prevention of HIV-infection
during breastfeeding. The
maternal viral load is higher
shortly after a new infection
resulting in an increased risk of
infection of the child.
Early treatment of sores or
thrush in the mouth of the
infant. Sores in the infant's mouth
make it easier for the virus to enter
the infant's body.
The risk of HIV-infection has to be
compared with the risk of morbidity and
mortality due to not breastfeeding.
Breastfeeding is protective against death
from diarrhoea, respiratory and other
infections, particularly in the first months
of life. Breastfeeding also provides the
necessary nutritional and related
ingredients, as well as the stimulation
necessary for good psychosocial and
neurological development, and contributes
to birth spacing.
Breastfeeding saves lives
 For HIV-infected mothers,
especially in developing countries,
the decision to breastfeed or to
give breastmilk substitutes like
infant formula or modified cow's
milk provides a dilemma. While
breastfeeding increases the risk of
HIV-transmission to the child with
up to 15%, giving breastmilk
substitutes instead of breastmilk
increases the risk due to infectious
diseases like diarrhoea and
respiratory infections about 6
times during the first 2 months.

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 Many mothers in developing
countries cannot afford breastmilk
substitutes and lack access to clean
water, which is essential for their
safe preparation and use. Also in
many cultures there is a stigma
against not breastfeeding. A
mother living with HIV/AIDS
therefore faces many grave
difficulties: worries about her own
health and survival, the risk of
infecting her baby through
breastmilk, and the danger that her
baby will develop other health
problems if she does not
breastfeed.
 The risk of HIV-infection has to
be compared with the risk of
morbidity and mortality due to not
breastfeeding. Breastfeeding is
protective against death from
diarrhoea, respiratory and other
infections, particularly in the first
months of life. Breastfeeding also
provides the necessary nutritional
and related ingredients, as well as
the stimulation necessary for good
psychosocial and neurological
development, and contributes to
birth spacin.
Relative risk of infectious disease mortality among non -breastfed infants.
Age (months)

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References:
1. NACO, Guidelines for care of
HIVexposed infants and children
infants and children less than 18
months. New Delhi: National AIDS
Control Organization; 2010 Jan 24-36.
2. Sherman GG, Cooper PA, et al.
Polymerase chain reaction for
diagnosis for human
immunodeficiency virus infection in
infancy in low resource settings.
Pediatr Infect Dis J Med 2005:24:993-
7.
3. Violari A, Cotton MF, Gibb DM,
Babiker AG, Steyn J, Madhi SA, et al.
Early antiretroviral therapy and
mortality among HIV infected infants.
N Engl J Med 2008: 359:2233-44