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Morbidity
and Mortality in Breastfed and Formula-Fed Infants of HIV-1 Infected
Women [Mbori-Ngacha D et al. JAMA 2001;286:2413] The
authors performed a randomized study of formula vs. breast fed infants
in Nairobi, Kenya to determine relative impact on morbidity and
mortality. At two years, the mortality rates in the two groups were
not significantly different, although HIV infection was associated
with a 9-fold increase in mortality. The incidence of diarrhea and
pneumonia were also similar in the two groups. Infants in the breast-feeding
arm tended to have better nutritional status during the first six
months and the HIV free survival at two years was significantly
higher in the formula arm at two years. The authors concluded that
formula feeding can be a safe alternative to breast-feeding if there
is appropriate education and access to clean water in resource poor
settings.
| Morbidity
and Mortality of Breastfed vs. Formula Fed Infants In Nairobi |
| |
Breastfed
n = 185 |
Formula
n = 186 |
| Mortality
at 2 years |
24.4%
|
20.0% |
| Diarrhea
(/ 100 person-yrs) |
149
|
155 |
| Pneumonia
(/ 100 person-yrs) |
62 |
62 |
Comment: This issue is controversial because breast feeding is
known to be a mechanism of HIV transmission in up to 40% [MMWR
2001;50; RR-19:59], but breast feeding also significantly reduces infant
morbidity due to infectious diseases and malnutrition [Lancet 2000;355:451;
BMJ 1999;318:1316; JAMA 2001;286:2462]. As a result, WHO
has recommended that women in resource-poor settings be fully informed
of the risks and benefits of breast feeding and get support for whatever
decision they make. This study seems to support the potential value of
alternatives to breast-feeding. Nevertheless, an editorial response by
Laura Guay and Andrea Ruff [JAMA 2001;286:2462] points out that
there may be some selection bias in this report since only 18% of seropositive
women were included based on eligibility criteria. They also conclude
that alternatives to breast milk were "unlikely to become standard
practice among the majority of seropositive women in sub-Saharan Africa."
Alternative strategies include exclusive breast-feeding with early weaning,
avoidance of breast feeding during breast inflammation, antiviral prophylaxis
during breast-feeding, and vaccination.
posted 1/7/2002
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