Conclusions  The frequency of breast milk transmission of HIV-1 was 16.2% in this randomized clinical trial, and the majority of infections occurred early during breastfeeding. The use of breast milk substitutes prevented 44% of infant infections and was associated with significantly improved HIV-1–free survival.

Detection of human immunodeficiency virus type 1 (HIV-1) in breast milk by culture and polymerase chain reaction does not necessarily mean that breastfeeding is a route of transmission, although evidence from several case-reports points in that direction. We undertook a systematic review of published studies meeting criteria that allowed determination of quantitative risk of transmission via breastfeeding. Based on four studies in which mothers acquired HIV-1 postnatally, the estimated risk of transmission is 29% (95% Cl 16-42%). Analysis of five studies showed that when the mother was infected prenatally, the additional risk of transmission through breastfeeding, over and above transmission in utero or during delivery, is 14% (95% Cl 7-22%). Where there are safe alternatives to breastfeeding, universal named testing of pregnant women would provide an opportunity to advise more infected women not to breastfeed and might thereby reduce the number of vertically infected children. Since breastfeeding protects against infant deaths from infectious diseases, breastfeeding is still recommended where infectious diseases are a common cause of death in childhood, despite the additional risk of HIV transmission. (

“The question of whether or not to breastfeed is not a straightforward one,” says Professor Hoosen Coovadia from the Africa Centre. “We know that breastfeeding carries with it a risk of transmitting HIV infection from mother to child, but breastfeeding remains a key intervention to reduce mortality. In many areas of Africa where poverty is endemic, replacement feed such as formula milk or animal milk is expensive and cannot act as a complete substitute. The key is to find ways of making breastfeeding safe.”

In the developed world, the risk of transmission of HIV from mother to child has been dramatically reduced from about 25 per cent to less than 2 per cent thanks to the use of antiretroviral therapies, exclusive formula feeding regimes and excellent healthcare systems, but these are not available in resource-poor areas. (

More than 200,000 of the 500,000 new human immunodeficiency virus (HIV) infections that occur each year in children are the result of transmission of the virus through the mother’s breast milk

he availability of preliminary results of the study by Kuhn et al. in 2006 influenced the World Health Organization to change its recommendation that breast-feeding should preferably cease at 6 months to an alternative stance that “at 6 months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe (AFASS), continuation of breastfeeding with additional complementary foods is recommended.”12 In contrast, recently published observational cohort studies among populations in Africa have provided compelling evidence that late postnatal transmission of HIV through breast-feeding can be substantial, increasing the risk of HIV infection by a factor of about 7.5.13,14 A recent nonrandomized, urban cohort study in Ivory Coast that offered short-course regimens of combinations of antiretroviral drugs to prevent mother-to-child transmission together with either exclusive formula-feeding or shortened breast-feeding found that both of these feeding options significantly reduced postnatal transmission of HIV at 18 months as compared with long-term breast-feeding, without increasing mortality.15
AUTHORS connected with ABBOT, etc…

In the developed world, mothers with HIV avoid breastfeeding altogether and can instead feed their infants with formula. But in many low- and middle-income countries, formula feeding of infants is neither feasible nor safe. Sanitation is lacking, and clean water to mix formula is often not available. Many families cannot afford infant formula.
It may be difficult to obtain enough fuel to boil the water to prepare formula safely. Formula-fed infants miss out on protective antibodies – passed on through breast milk – that ward off other deadly diseases. Formula feeding may also carry a social stigma in certain settings – the practice may be seen as a sign that a woman has HIV infection.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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