Breast-feeding and HIV

Last month’s results published from the Breast-feeding, Antiretrovirals and Nutrition (BAN) study conducted here in Malawi revealed that “longer breast-feeding along with antiretroviral drugs can lower HIV transmission to babies”. The research was conducted by the University of North Carolina in Lilongwe, between April 21, 2004 and January 28, 2010. The study involved more than 2,300 HIV-infected breast-feeding mothers and their newborn babies.

For most babies, breast-feeding is without question the best way to be fed, but unfortunately breast-feeding can also transmit HIV. The breast-feeding conundrum: do the benefits of breast-feeding, essential nutrients for a growing baby and chemical agents that protect the child from illness outweigh the risks of HIV transmission?

In 2010, research from the BAN study found that giving daily antiretroviral drugs to HIV-infected mothers or their breast-feeding babies for 28 weeks is safe and effective for preventing mother-to-child HIV transmission through breast milk. This evidence contributed to the World Health Organisation’s recommendation that antiretroviral drugs be given to either HIV-infected mothers or infants throughout breast-feeding.

In the most recent results from the BAN study, women were advised to stop breast-feeding between 24 and 28 weeks, much earlier than the Malawian norm of 24 months recommended for the general population. Researchers found that stopping breast-feeding before six months, also known as early weaning, is of little value in preventing HIV transmission nor is it safe for infant survival. The overall risk of HIV transmission was significantly greater at 48 weeks in the breast-feeding only group of infants than in the maternal ART group and the infant ART group.

“In resource-limited settings where no suitable alternative to breast-feeding is available, antiretroviral prophylaxis given to mothers or infants might decrease HIV transmission. Weaning at 6 months might increase infant morbidity.”

The report also noted that infant illnesses (diarrhoea, malaria and TB), growth problems, and deaths significantly increased after early weaning. The researchers emphasise two key issues: firstly, in Malawi breast-feeding is essential for babies and that there should be no early weaning and secondly, ARVs given to either the mother or child should be continued throughout the breast-feeding period.

My conclusion is that breast-feeding with ARVs for longer than 6 months might be advantageous.

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