Morbidity and Mortality in Breastfed and Formula-Fed Infants of HIV-1–Infected Women

Abstract

In this randomized clinical trial, infants assigned to be formula fed or breastfed had similar mortality rates and incidence of diarrhea and pneumonia during the first 2 years of life. However, HIV-1-free survival at 2 years was significantly higher in the formula arm. With appropriate education and access to clean water, formula feeding can be a safe alternative to breastfeeding for infants of HIV-1-infected mothers in a resource-poor setting.

Factors influencing the infant feeding choices of HIV-positive mothers at a level two hospital in Cape Town

“…A randomised trial in urban Kenya found that formula-fed infants whose mothers had access to clean water, free formula and frequent health care worker support had a 40% lower risk of HIV transmission, but their mortality rates were similar to the breastfeeding group (Mbori-Ngacha, Nduati, John, Reilly, Richardson et al, 2001). …”

Disease Progression in Children with Vertically-Acquired HIV Infection in Sub-Saharan Africa: Reviewing the Need for HIV Treatment

“…In HIV infected children up to 2 years of age breastfeeding significantly reduced mortality (HR 0.36) when compared to not breastfeeding [85]. However, a second study also based in Nairobi found a non significant difference in survival to 2 years age in vertically infected children, with 46.0% mortality in breast fed children compared to 40.2% in formula fed children [56]. A large meta-analysis also found that after adjusting for a child's infection status, breastfeeding had no impact on the mortality of HIV exposed children [65].…”

“…In a follow-up study of children enrolled in a PMTCT trial in Cote d'Ivoire and Burkina Faso [27] ~ half of all infected children died before their first birthday. In a formula feeding trial [56], in Nairobi, the overall two year estimated mortality rate was 46.0% in the breast fed and 40.2% in the formula arm among infected children, compared to 8.1% and 10% respectively for uninfected children ( Table 3).…”

Optimizing HIV‐1‐specific CD8+ T‐cell induction by recombinant BCG in prime‐boost regimens with heterologous viral vectors

“…Although antiretroviral treatment substantially decreases mother-to-child transmission (MTCT) of HIV-1 [3], it is not ideal due to the cost, requirement for daily compliance, side effects and possible development of drug resistance. Because breast milk provides essential nutrients and protection against other diseases in the early days of life [4,5], formula as an HIV-1-free alternative is recommended only if it is acceptable, feasible, affordable, sustainable and safe (AFASS) and thus it is not an option for many HIV-1-positive mothers in Africa. The best hope for protecting newborns and infants in the 'South' (and in the 'North') against acquiring HIV-1 from their infected mothers while breastfeeding remains the development of safe, effective and accessible adult and pediatric vaccines [6].…”

“…other diseases in the early days of life [4,5], formula as an HIV-1-free alternative is recommended only if it is acceptable, feasible, affordable, sustainable and safe (AFASS) and thus it is not an option for many HIV-1-positive mothers in Africa. The best hope for protecting newborns and infants in the 'South' (and in the 'North') against acquiring HIV-1 from their infected mothers while breastfeeding remains the development of safe, effective and accessible adult and pediatric vaccines [6].…”