Exclusive and Mixed infant feeding, and the Risk of HIV transmission to the infant

‘EXCLUSIVE feeding’ refers to breastfeeding and predates HIV, but in developing countries has since come to mean safer infant feeding for HIV positive mothers. Strictly, this meaning precludes the addition of anything (water; solids; western or traditional medicine; animal or formula milk) to breastfeeding – by any route, oral or rectal. It is recommended for 4 months and no longer than to 6 months, followed by rapid weaning.

‘MIXED feeding’ is a wider term that refers to a failure, or rather lack of exclusive breastfeeding in the first 4 to 6 months. However, ‘mixed feeding’ also includes the adding of occasional breast-milk to formula feeding or after weaning, as this carries the same risk.

THE RISK (for those new to the field) is thought to be due to micro-trauma to the bowel by any additives, even water, which in the presence of any HI virus in the breast-milk, provides an entry point to the infants bloodstream that allows for HIV transmission. Statistical evidence implies that in exclusive breastfeeding the HI virus is digested like all other protein, with minimal risk of transmission. On the other hand, bottle-fed children in developing countries run a six-fold greater comparative risk of death in the first two months of life than those that are breast-fed (WHO Collaborative Study, 2000) from infectious disease, mostly diarrhoea.

ALSO RECOMMENDED (*) for poorly resourced HIV positive mothers, to support exclusive breast-feeding: -

• Safer sex to prevent HIV reinfection
• Stopping breast feeding when there are cracked or bleeding nipples
• Rapid treatment for oral thrush / ulcers in the infant
• Where available, prophylactic ARV treatment for the infant

(*) ‘Practical recommendations’ by Prof. Coutsoudis, quoted in Women & HIV; The Dilemma of Breast-Feeding, Bulletin of Experimental Treatments for AIDS; Winter 2002