Nutrition and HIV/AIDS: A Training Manual - Linkages Project

DNA (cell-associated virus) in colostrum than in breastmilk. Other studies (Nduati etal 1995) indicate higher proportions of infected cells in breastmilk than in colostrum.Breastfeeding saves lives (slide 15)Replacement feeding prevents breastmilk transmission of HIV, but in resourcelimitedsettings, the risk of death from artificial feeding must be weighed againstthe risk of HIV infection. Several studies have reached the same conclusion aboutthese competing risks: with high levels of infectious disease mortality, breastfeedingis safer than artificial feeding for infants up to a certain age when the mothers areHIV infected.If infant mortality is < 80/1,000 live births and the risk of death from artificialfeeding is < 2.5 times the risk of death of exclusively breastfed infants, infants ofHIV-infected mothers are safer when fed artificially. The LINKAGES risk model forHIV and infant feeding assumes that if HIV prevalence among child-bearing women is20 percent, the relative risk from not breastfeeding is 3 times that, and 17 percentof infants uninfected at delivery who are breastfed by an infected mother willbecome infected. Even in situations where a greater percentage of children die fromHIV-related illness, the overall risk of mortality is still greater for children who fallinto the categories of no breastfeeding at all or the spillover category of mixedfeeding (Ross 1999).HIV and infant feeding risk analysis (slide 16)Additional risk factors for breastfeeding and MTCT are described below, along withan indication of the strength of evidence for each risk factor.Maternal viral loadMaternal viral load is higher in mothers with recent HIV infection or advanceddisease. The risk of MTCT during breastfeeding nearly doubles if the motherbecomes infected while breastfeeding. An analysis of four studies in which mothersbecame infected post-natally found a 29 percent risk of transmission throughbreastfeeding (Dunn et al 1992). As discussed under the Intervention section below,191