Breast is still best even when HIV prevalence is high, experts say
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7352.1474/b (Published 22 June 2002) Cite this as: BMJ 2002;324:1474
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The problem with a general recomendation of the WHO/UNICEF about
continue the breastfeeding in infants born from HIV mothers in development
countries, is that not all the development countries are in Africa. I live
in a develpment country and Mexico, and we does not have the same
conditions than subsaharan countries. Even in Mexico is not the same the
north, the centre and the south of the country.
If the WHO/UNICEF recomendation is a general recomendation it has a lot of
exceptions.
Maybe only if the patient live in extreme poberty, without potable water,
etc., I recomend to continue the breastfeeding.
Competing interests: No competing interests
Had the acquired immune deficiency syndrome been first described in
Africa rather than San Francisco, the continuing muddled response to this
tragedy might have been very different. Dr Togun expresses valid
concern regarding the differing approach to breast feeding in HIV
transmission in countries with low/medium prevalence and those with high
prevalence as advised by 'experts'. He wonders why, since prevention is
much better and cheaper than cure, all the best available attempts to
prevent mother to child transmission are not fully utilised to reduce the
burden of this disease in the developing world. The choice it seems
lies between lethal (but treatable) childhood diarrhoea and the attendant
morbidity and mortality of HIV.
The answers to Dr Togun's concerns are to be found in a philosophy in
western medicine which placces the 'stigma' of diagnosis to individuals
ahead of the safety and welfare of the general population. Herein lies
the antipathy to HIV screening in pregnanacy to which western HIV experts
and policy makers have subscribed. The cardinal principle of infectious
disease containment, -know it's whereabouts and prevent it's transmission
to susceptibles, was sacrifced to political correctness.
Eleven years ago this writer attempted to outline the incongruity of
routine neonatal metabolic screening as this related to HIV screening in
pregnancy and the prevention of HIV transmission in breast milk (CMAJ
1991; 44 (3) 280, 144 (8) 955, 145 (3) 199, 145 (10) 1197-8 and
Pediatrics 1991; 88 (3) 657). In each case the suggestion that routine
HIV screening in pregnancy was fiercely resisted. While 'tincture of
time' would appear to have endorsed the prescience of such sccreening, one
notes that the voices of dissent are now 'expert' advisors to UNAIDS.
Dr Togun's letter reminds one of the 'Emperor's New Clothes' fable.
His statement of the obvious needs to be heard. Meanwhile there is the
dilemma of where to seek advice. Only one country has treated HIV
appropriately and humanely using conventional public health measures.
That country is Cuba.
James E Parker
Competing interests: No competing interests
If the so-called child health specialist advocate the use of formular
feeds to reduce postnatal transmission in the low/medium prevalent
developed world,why not the same in the high prevalent countries which are
mainly underdeveloped or developing countries?
It is clear that for now prevention is much better and cheaper than
cure with regards to HIV and most other infectious diseases too.Thus all
the best available attempts to prevent mother to child transmission must
be fully utilised to reduce the burden of this disease in the developing
worlds.
The argument that a child that is not breastfed stand a much higher
chance of dying from diarrhoea related disease than a breast-fed child is
sensible when we are talking of easily curable or treatable infections,not
HIV with its attendant morbidity and mortality especially in sub-saharan
Africa.
I believe that what is good for the goose is also good for the
gander.
Thank you.
Competing interests: No competing interests
The news article "Breast is still best even when HIV prevalence is high, experts say" by Roger Dobson
(BMJ 2002; 324: 1474b) points out some important issues regarding the risks and benefits of making public health policy regarding vertical transmission of HIV. However, it fails to mention yet one more potential effect of providing formula to HIV positive mothers: possible *increased* transmission of the virus.
Although further research is clearly needed, a recent study demonsrated that the rate of HIV transmission was low in the exclusively breastfed group, and that formula supplementation of breastfeeding was associated with a higher transmission rate (Coutsoudis A et al. Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001 Feb 16; 15(3): 379-87.)
Although breastfeeding is very prevalent in many of the countries where HIV is prevalent, the rate of *exclusive* breastfeeding tends to be low. If Coutsoudis' findings are duplicated, the lack of exclusive breastfeeding could be an explanation for a large part of the current reported transmission rates via breastfeeding. This would be another reason to promote exclusive breastfeeding instead of increasing further the rate of formula feeding.
Alicia Dermer, MD, Clinical Associate Professor, Department of Family Medicine, University of Medicine and Dentistry - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Competing interests: No competing interests
AnotherLook is a nonprofit
organization dedicated to gathering information, raising critical questions, and
stimulating needed research about breastfeeding in
the context of HIV/AIDS.
We look for scientific proof to determine whether or not infectious HIV virus is
present in breast milk and is transmitted from mother to baby through
breastfeeding. We question recommendations that are based solely on the
possibility of virus transmission instead of on maximizing the probabilities for
good
infant health. We call for clear, published scientific evidence as to the type
and manner of feeding which will minimize infant morbidity and mortality.
For more information, we encourage readers to visit our website at <http://www.anotherlook.org>.
For more information, we encourage readers to visit our website at <http://www.anotherlook.org>.
Competing interests: No competing interests
More Research is Needed
I do not agree with the proposal of breast feeding in HIV positive
mother in any contest for the following reasons.
1. Infectious diseases in children in deleloping countries are both
preventable and treatable with out much cost to the family.
2. Breast feeding in HIV posive circumstances negate all efforts at
antenatal prevention of the disease.
3. Not only is the life of the baby at risk but breast feeding also places
a demand on an already ill mother whose immune syastem is compromised.
4 People suggesting breast feeding in developing countries should not loose
sight of the fact that that is where drug treatment is not at its best so
where primary prevention in the child is more cost effective than drug
treatment.
5. How do you suggest definite infection with HIV inorder to prevent an
"infectious" disease which has not occured and may indeed not and to which
appropriate preventive measure including maternal counseling and education
have not been shown to be ineffective at prevention.
6. Is this campaign an attempt to increase the prevelence of HIV/AIDs in
the weak.
Competing interests: No competing interests