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Formula Safe for Babies of HIV-Positive Women

But African study has many ifs and buts

TUESDAY, Nov. 20, 2001 (HealthDayNews) -- African women with the AIDS virus can safely feed their infants formula instead of breast milk as a way to cut down on the transmission of HIV, a new study says.

Researchers have found that infant formula and breast-feeding are roughly the same when it comes to shielding babies from death, diarrhea and respiratory infections in the first two years of life. After that, the burdens of increased HIV infection among breast-fed children mounts, and the death rates between the two groups diverge.

Experts say the findings are rich in ifs and buts that make sweeping generalizations and policy decisions difficult. Nursing, for example, is a winner for early childhood nutrition, while formula-fed infants are protected from HIV infection. What's more, formula is expensive and requires a constant supply of clean water, two factors that confound its widespread use in developing countries.

The study, by researchers in Kenya -- which has a staggering problem with AIDS and HIV infection -- and the United States and Europe, appears in the Nov. 21 issue of the Journal of the American Medical Association.

Earlier this year, researchers in Kenya reported that women who breast-fed were three times more likely than mothers who used formula to die of AIDS or complications from HIV infection within two years of delivering. That effect may be related to the energy nursing saps from new mothers.

Another Kenyan study showed that nursing sharply raises a baby's risk of HIV infection compared with formula feeding. That risk can be reduced with drugs and other strategies, including advising women not to nurse when they have sores on their nipples that shed the deadly organism.

Giving babies formula is an obvious way to eliminate their risk of mother-to-child HIV transmission after birth (though it doesn't affect maternal-fetal infection). But formula-fed babies have been shown to suffer more diarrhea, pneumonia and other respiratory diseases than breast-fed babies.

In the newest work, a team led by Dr. Dorothy Mbori-Ngacha of the University of Nairobi followed 371 babies born to HIV-positive women between 1992 and 1998, comparing those whose mothers gave them infant formula and those who were breast-fed.

Over the next two years, the death rate among the children was essentially the same -- 20 percent vs. 24 percent -- even after adjusting for the impact of HIV infection, which increased the babies' chances of dying nine-fold. The same was true for the incidence of diarrhea -- a major public health problem in the developing world -- and the incidence of pneumonia and other illnesses the researchers tracked.

The researchers say their study has some caveats. For example, 30 percent of the children given formula also nursed at times, possibly skewing the results. And the researchers relied on women in the study to remember and report the illnesses their children suffered, opening the door to errors.

Still, the researchers claim, "The use of formula to prevent HIV-1 transmission can be a safe and viable option even in resource-poor settings, if maternal education, clean water, a supply of formula and access to health care are available."

Those are very big ifs, says an editorial accompanying the journal article. Many communities in sub-Saharan Africa, where HIV rages, lack access to clean water; childhood nutrition is dismal and infant mortality soars, write Drs. Laura Guay and Andrea Ruff, AIDS experts at Johns Hopkins University. The findings "are not generalizable and should be confirmed before influencing public health policy," the write.

Dr. Marie-Louise Newell, a pediatric infection specialist at the Institute of Child Health, in London, who has studied AIDS in Africa, says the latest research gives neither policy-makers nor public health workers in the field much guidance.

"The risks associated with formula feeding are different in different populations," depending on both local and individual variables. "It's a big problem in translating it for national policy-makers sitting in Swaziland or Argentina, or on an individual basis to go through the individual circumstances a woman is faced with," Newell says.

What To Do

For more on HIV, try the University of California at San Francisco, UNAIDS or aidsmap.

To learn more about the benefits of breast-feeding, visit Jane's Breastfeeding & Childbirth Resources, the U.S. National Library of Medicine or the University of Michigan.

SOURCES: Interview with Marie-Louise Newell, M.D., Ph.D., professor of pediatric epidemiology, Institute of Child Health, London; Nov. 21, 2001 Journal of the American Medical Association
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