Study Finds Breastfeeding Results Lowers Risk of HIV Transmission

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“HIV in Populations where Breastfeeding is Essential for Child Survival: Trials and Tribulations”, was the title of a Public Lecture presented at the Nelson R. Mandela School of Medicine by Dr Louise Kuhn of the Columbia University in the United States.

‘There have been many trials and tribulations in the field of HIV and breastfeeding which have helped us to better understand the problems being experienced around the African continent with respect to breastfeeding,’ said Kuhn.

Kuhn presented data on a study she conducted in Lusaka, Zambia, which showed that exclusive breastfeeding resulted in a lower probability of HIV transmission from mother to child.

Kuhn found that exclusive breastfeeding was welcomed by the community as it gave women something within their own control that they could do to protect the health of their babies.  But for those women who chose non-exclusive breastfeeding there was 3.5-fold increased risk that the baby would be infected.

Promotion of exclusive breastfeeding was also a non-stigmatising message as it provided for both HIV negative and positive people.

Kuhn said the relationship between exclusive breastfeeding and transmission had proved to be a really robust association that had been supported in several other studies.  However, it remained a mystery why exclusive breastfeeding produced positive results but contributing factors included reduced antigen exposures which could reduce gut inflammation, changes in gut microbiota, and increased concentration of soluble factors in breast milk.

Kuhn presented data from her Zambian study which showed that exclusive breastfeeding reduced mastitis (inflammation of breast tissue) and lessened viral shedding in breast milk.  This could be because of the regularity and frequency of breastfeeding that occurred when breastfeeding was exclusive.

Her study among 957 HIV-positive women in Zambia also showed that stopping breastfeeding early created many problems, including increased concentrations of HIV RNA in the milk.

Kuhn said formula feeding was not a safe and acceptable way to provide nutrition for an infant.  ARVs, when used either by the mother or the infant, produced a dramatic reduction in the risk of HIV transmission and needed to be taken throughout the breastfeeding period and continued for a reasonable duration afterwards to help prevent further breast milk exposure.

* Kuhn is a Professor of Epidemiology at Columbia University where she manages an active research programme focused on mother-to-child HIV transmission and HIV care and treatment of children.

-           Zakia Jeewa