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

The Code of Marketing of Breastmilk Substitutes and HIVThe International Code of Marketing of Breastmilk Substitutes is especially importantin the context of HIV and infant feeding. The Code protects optimal breastfeedingfor most infants but also protects artificially fed infants by ensuring that all productsare clearly labeled for proper preparation and that the choice of replacementfeeding is based on non-commercial information. Countries may purchase infantformula and provide it free or at subsidized cost. Care must be taken to ensure thisformula is used exclusively. Labeling is important in local languages on safepreparation and use. Note: Address whether and how the Code is implemented inyour country.A study in Zvitambo, Zimbabwe, is measuring the effect of infant feeding counselingon feeding decisions (box 4).Box 4 ZVITAMBO studySince 2001 the ZVITAMBO study in Zimbabwe has followed 14,000 mother-baby pairs(approximately 30 percent of them HIV positive and 70 percent HIV negative) for 12–24 months to measure the impact of infant feeding counseling on several outcomes,including mother-to-child transmission (MTCT). ZVITAMBO has provided high-dosevitamin A supplements to mothers (400,000 IU) or babies (50,000 IU) within 96 hoursof delivery. The study has investigated infant morbidity and mortality, rate andtiming of MTCT during breastfeeding, and the incidence of HIV infection among postpartumwomen. Results from this and other studies will help to inform PMTCTrecommendations.Short-course perinatal ARV prophylaxis (slide 33)Short-course perinatal ARV prophylaxis is to be distinguished from long-term ARVtherapy for treating HIV-infected people. The former regimens are prescribed toprevent mother-to-transmission of HIV and not to treat the HIV-infected mother. Thethree most common courses are listed below.• Administration of Zidovudine (ZDV) to women from 36 weeks gestation throughlabor and delivery, with additional prophylactic ZDV to the mother after birthin some regimens. ZVD is a nucleoside analogue. Retrovir is the commercialname.204