Abstract

PIP: Conflicting advice is available on breast feeding for HIV-positive mothers to developing countries. WHO recommends that mothers regardless of HIV status should continue breast feeding where alternatives are not safe. In the US, CDC advises against breast feeding for HTLV-III/LAV-infected women to avoid transmission to an as yet unaffected newborn. The British have a similar recommendation. Industrialized countries tend to set the standard for developing countries, even though CDC has not directed its policy to developing countries. This study examined the effects of breast feeding by HIV-infected mothers on infant/child mortality compared with bottle feeding. Countries are selected with varying levels of infant mortality (5%, 10%, and 15%). The risk of infection/100,000 uninfected infants is hypothetically modeled. Calculations are made 1) for the number of expected deaths among breast-fed infants due to HIV-related infections from breast milk and to other diseases, and the number of deaths for other diseases is uninfected babies; 2) expected deaths among bottle-fed infants; and 3) total deaths for all babies. It is assume that HIV transmission through breast milk is 20%, that 95% of HIV-infected babies will die before 1 year, and that there are 4 relative risks of death (3 the lowest; 4; 5; and 6 the highest risk) due to diseases of childhood for bottle-fed babies. The confirmed expectation was that reduction in breast feeding will contribute to greater infant mortality. Breast feeding as a method of HIV transmission is still open to question, particularly when mothers are asymptomatic seropositive. The results show that in countries with a 10% infant mortality rate, and the lowest relative risk of 3, 30,000/100,000 uninfected bottle-fed babies are expected to die, however, if breast fed by HIV-infected mothers with a 5% transmission rate, mortality would be 14,000/100,000. Only at a 20% infant mortality rate do expected HIV deaths among breast-fed babies approach the breast-fed babies approach the rate for bottle-fed babies. The likely transmission rate is 1% or 11,000 deaths. Breast milk transmission rates of 1% would yield rate is 1% or 11,000 deaths. Breast milk transmission rates of 1% would yield an estimated 950 additional infant deaths, at 5% 4750, at 10% 9500, and 20% 19,000. These numbers contrast with a 10% infant mortality among bottle-fed babies and 20,000 deaths.