[pronut-hiv] Potential impact of infant feeding recommendations on mortality

["ProNut-HIV" <pronut-hiv@healthnet.org>]

Cross posted from PMTCT forum

Potential impact of infant feeding recommendations on mortality and
HIV-infection in children born to HIV-infected mothers in Africa: a
simulation

BMC Infectious Diseases 2008, 8:66 doi:10.1186/1471-2334-8-66

Abstract
Background: Although breast-feeding accounts for 15-20% of
mother-to-child transmission (MTCT) of HIV, it is not prohibited in some
developing countries because of the higher mortality associated with not
breast-feeding. We assessed the potential impact, on HIV infection and
infant mortality, of a recommendation for shorter durations of exclusive
breast-feeding (EBF) and poor compliance to these recommendations.
Methods: We developed a deterministic mathematical model using
primarily parameters from published studies conducted in Uganda or Kenya
and took into account non-compliance resulting in mixed-feeding
practices. Outcomes included the number of children HIV-infected and/or
dead (cumulative mortality) at 2 years following each of 6 scenarios of
infant-feeding recommendations in children born to HIV-infected women:
Exclusive replacement-feeding (ERF) with 100% compliance, EBF for 6
months with 100% compliance, EBF for 4 months with 100% compliance, ERF
with 70% compliance, EBF for 6 months with 85% compliance, EBF for 4
months with 85% compliance

Results: In the base model, reducing the duration of EBF from 6 to 4
months reduced HIV infection by 11.8% while increasing mortality by
0.4%. Mixed-feeding in 15% of the infants increased HIV infection and
mortality respectively by 2.1% and 0.5% when EBF for 6 months was
recommended; and by 1.7% and 0.3% when EBF for 4 months was recommended.
In sensitivity analysis, recommending EBF resulted in the least
cumulative mortality when the a) mortality in replacement-fed infants
was greater than 50 per 1000 person-years, b) rate of infection in
exclusively breast-fed infants was less than 2 per 1000 breast-fed
infants per week, c) rate of progression from HIV to AIDS was less than
15 per 1000 infected infants per week, or d) mortality due to HIV/AIDS
was less than 200 per 1000 infants with HIV/AIDS per year.

Conclusion: Recommending shorter durations of breast-feeding in infants
born to HIV-infected women in these settings may substantially reduce
infant HIV infection but not mortality. When EBF for shorter durations
is recommended, lower mortality could be achieved by a simultaneous
reduction in the rate of progression from HIV to AIDS and or HIV/AIDS
mortality, achievable by the use of HAART in infants.