Re: [pronut-hiv] Better subject: Alternatives to breastmilk cuts HIV risk for babies

["Kristof Nordin" <nordin@eomw.net>]

The title of this e-mail was VERY misleading (bottlefeeding cuts HIV risk
for babies).  It is NOT Bottlefeeding cutting the risk, it is artificial
feeding (alternatives to breastmilk) that cut the risk.  Bottlefeeding can
be a dangerous practice, and it is an unecessary mode of feeding an infant.
After reading this abstract, I see that they do metion that cup feeding is a better choice than bottlefeeding.

Please let us be careful what subject headings we are using as people may
not take the time to read the actual abstract.

Stacia
~~~~~~~~~~~~~~~~~~~~~~
Stacia Nordin, RD
Nutrition Consultant
Specialist in food security, sustainable agriculture, HIV/AIDS

Part-time Crisis Corps Coordinator
US Peace Corps, PO Box 208, Lilongwe, Malawi
+265  1-757-157  (work phone)
+265  1-751-008  (work fax)
+265  9-960-613  (work cell)

Personal Information
+265  1-707-213  (home)
+265  9-926-153  (home cell)
~~~~~~~~~~~~~~~~~~~~~~


----- Original Message -----
From: "ProNut-HIV" <pronut-hiv@healthnet.org>
To: <pronut-hiv@healthnet.org>
Sent: Sunday, March 21, 2004 11:19 PM
Subject: [pronut-hiv] Bottle feeding cuts HIV risk for babies


> Crossposting from AIDSMAP
> -------------------------
>
> Keith Alcorn
>
> Bottle feeding cuts HIV risk for babies
>
> A two year study of mothers and babies in Kenya has found that formula
feeding of babies born to HIV-positive mothers reduces the risk of infant
seroconversion by almost half (44%).
>
> A reduction of transmission of this degree, note the investigators, is
equivalent to that seen in short-course zidovudine (AZT) studies carried out
in Cote D'Ivoire and Burkina Faso.
>
> Six months of formula feeding in Nairobi costs about #190 ($300).
>
> The study
>
> 425 HIV-positive mothers were enrolled at a Nairobi antenatal clinic and
randomised to formula feeding or breastfeeding of their babies.
Unsurprisingly, compliance to the assigned method of feeding was higher in
the breastfeeding group (96% vs 70%), and compliance with formula feeding
was strongest in women with more advanced HIV disease and higher viral load.
68 mother-infant pairs were lost to follow-up during the study.
>
> After two years of follow-up, 36.7% of the infants in the breastfeeding
arm were HIV-positive, compared to 20.5% in the formula feeding arm. 44% of
the infections in the breast feeding arm were thus attributable to breast
feeding, and 75% of infections are estimated to have occurred in the first
six months. However, the researchers warned that their study does not answer
the question of when most breast feeding transmissions occur.
>
> Overall mortality was similar in both arms. 24.4% of infants in the
breastfeeding arm had died after two years, compared with 20% of infants in
the formula feeding arm. These rates are higher than the norm for Nairobi,
but not unusual in a cohort of HIV-infected women. Amongst infants proven to
be HIV-free the death rate was higher in the breastfeeding arm than the
formula feeding arm.
>
> In an accompanying review of how to prevent mother to child transmission
in resource-poor countries, Dr Kevin de Cock recommends that cup feeding
rather than bottle feeding is preferable in resource-poor countries, due to
the difficulty of sterilising feeding bottles. He also emphasises the
importance of access to clean water supplies. In the Nairobi cohort all
women had access to clean water.
>
> If women with HIV choose to breast feed, "early weaning as soon as the
infant can take adequate replacement food seem appropriate". Weaning is
recommended at around six months in cases where formula feeding is not
possible, and prolonged breast feeding after six months of age continues to
carry a risk.
>
> Women who breastfeed should be encouraged to use condoms with their
partners during the breastfeeding period, despite the contraceptive effect
of breastfeeding. This is because women exposed to HIV during this period
are at especially high risk of transmitting HIV in breast milk.
>
> References
>
> De Cock K et al. Prevention of mother to child HIV transmission in
resource poor countries: translating research into policy and practice.
Journal of the American Medical Association 283 (9): 1175-1182, 2000.
>
> Nduati R et al. Effect of breastfeeding and formula feeding on
transmission of HIV-1: a randomized clinical trial. Journal of the American
Medical Association 283 (9): 1167-1174, 2000.
>
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