0714 Finally, the definitive KZN data on exclusive breast feeding and HIV

At the time when HIV/AIDS interventionists were focusing on the knowledge that breast milk presented a risk for transmission of HIV, and preventive strategies therefore focused on funding for and access to artificial infant feeds, Coutsidis and colleagues in KwaZulu-Natal (KZN) published their data from vitamin A trials, in which a post-hoc analysis suggested that exclusive breast feeding was in fact the preferred mode of feeding for infants born to HIV-positive mothers. KZN represents 7.6% of South Africa’s land area but includes some 20% of the population (mostly rural), with HIV/AIDS prevalence rates that are considerably higher than those in other provinces. Given this HIV risk and while others around the country grappled with the information on breast feeding, those faced with the realities of the pandemic continued to promote breast feeding in their communities (irrespective of HIV status), while also formally and specifically studying whether exclusive breast feeding was protective or added to the risk of transmission. Their data have now been published in the Lancet, enabling infant feeding guidelines for HIV-positive mothers to be refined. Some 1200 at-risk infants were followed up and the evidence is clear: in an environment in which single-dose nevirapine was available to mothers and infants, when HIV-positive mothers breastfed exclusively, those who were negative at 6 weeks had only a low (~4%) risk of infection (overall rates were higher, but also represented prenatal and intrapartum transmission). This transmission rate is significantly lower than the 10-20% previously cited in studies which did not distinguish between modes of feeding. Mixed feeding before or after 14 weeks increases the risk by a factor of ~2, and the addition of solids increases the risk by almost 11 times. Furthermore, mortality by 3 months of age for replacement-fed babies was more than double that of those who were exclusively breastfed. This study is the first in which measurement of transmission by feeding method was the primary aim, and the result and the success of counselling have policy implications because they show not only the effectiveness but also the feasibility of this intervention. With the assistance of skilled support from well trained, lay infant-feeding counselors, around 80% of mothers breastfed exclusively for at least 6 weeks, and 67% for at least 3 months. However, counsellors need training, management, support, and supervision, and health-care services need strengthening to provide this intervention.

Read more:
Lancet 2007; 369: 1107-16 and 1065-6
Lancet 1999; 354: 471-6
JAMA 2006; 296: 794-805
AIDS 2005; 19: 699-708