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Article written by Dr Susan Tawia, Manager, Breastfeeding Information and Research team, for the
July 2015 health professional member eNewsletter.
Last month, an Australian mother was ordered by a judge of the Family Court of NSW to stop
breastfeeding her child because she got a tattoo. In the judges opinion there was a risk that she
had contracted an HIV infection and she may infect her child through breastfeeding, despite the
fact that the woman had undergone a test for HIV infection which was negative. Very quickly, a
full bench of the Family Court of NSW overturned the decision. However, for a week the mother
was legally unable to breastfeed her child.
So, what is the current knowledge of the risks of a child contracting HIV from its mother if she
has been diagnosed with HIV and does the type of infant feeding (exclusive breastfeeding, mixed
feeding or artificial feeding) modify the risk?
Total number
exposed to HIV
Total number
with HIV
20042005
20062007
Number
50
Number
57
Year of birth
20082009
Number
79
2010
2011
Number
88
2012
2013
Number
108
mastitis
mixed feeding.
In terms of infant feeding choices, the most detrimental in terms of HIV transmission, is mixed
feeding a combination of artificial baby milk and breastfeeding.
The most recent evidence, of a growing body of evidence, comes from a study of HIV-free
survival rates according to the early infant-feeding practices in Nigeria (Angilj, Dabit,
Olutola, Ageda, Aderibigbe, 2015). This retrospective study in an anti-retroviral therapy program
compared HIV-free survival rates at 3 and 18 months according to the infant feeding pattern at
the 6th week of life. 801 HIV-uninfected infants at 6 weeks of life were studied 196
exclusively breastfed infants (EBF), 544 exclusively fed with artificial baby milk feeding and 61
mixed fed (MF).
The mixed-fed infants had the lowest HIV-free survival (HFS) rates: 75.7% at 3 months and
69.8% at 18 months. The HIV-free survival rate for exclusively-breastfed infants was 97.4% at 3
months and 92.5% at 18 months while exclusively artificial baby milk-fed infants had HIV-free
survival of 99.1% at 3 months and 86.2% at 18 months. The authors concluded that:
For a better HFS in our setting; MF must be avoided, efforts to deliver babies at term in
mothers with reduced viral load are advocated and EBF must be promoted as the safest and the
most feasible mode of infant-feeding.
The evidence is mounting that exclusive breastfeeding carries a significantly lower risk for the
transmission of HIV than do all other types of feeding routines that mix breastfeeding with other
liquids or solids.
Since 2007, there have been many papers published of studies of postnatal HIV transmission
rates when infants were exclusively breastfed. All studies were undertaken in Africa and mothers
and infants received antiretroviral therapy. Infant antiretroviral therapy usually continued for no
more than a week and infant HIV tests were conducted by 6 months (9 months in one study).
When mothers receive ongoing antiretroviral therapy and their newborn babies receive a week of
antiretroviral therapy and are exclusively breastfed for 6 months, the postnatal risk of HIV
transmission is 1% or less (Table 2).
Duration exclusive
breastfeeding (ebf)
Postnatal transmission of
HIV
Palombi et al 2007
6 months
0.8%
(2/225)
Kilewo et al 2008
18 weeks
1.0%
(4/389)
Kilewo et al 2009
Up to 6 months
0.9%
(4/441)
Marazzi et al 2009
6 months
0.6%
(2/341)
Peltier et al 2009
6 months
0.44% (1/227)
Thomas et al 2011
6 months
0.8%
(4/487)
If you wish to read more about the difficulties in deciding how infants of mothers diagnosed with
HIV should be fed, in particular questions related to the infants human right to adequate food
and to enjoyment of the highest attainable standard of health and questions about whether the
mothers right to make an informed choice should be suspended and whether the State and others
are obligated to provide specific kinds of information, then the chapter by George Kent on
HIV/AIDS, infant feeding and human rights inFood and Human Rights in Development would
be a useful place to start (Kent, G, 2005).
References
AIDS.gov (n.d.) A timeline of AIDS Retrieved July 21, 2015, from https://www.aids.gov/hivaids-basics/hiv-aids-101/aids-timeline/
Angilj, E. A., Dabit, O. J., Olutola, A., Ageda, B., & Aderibigbe, S. A. (2015). HIV-free
survival according to the early infant-feeding practices; a retrospective study in an anti-retroviral
therapy programme in Makurdi, Nigeria. BMC Infectious Diseases, 15(1), 132.
Australian Bureau of Statistics (2014). 3301.0. Births, Australia, 2013. Retrieved July 6, 2015,
fromhttp://www.abs.gov.au/ausstats/abs@.nsf/mf/3301.0
Australian Federation of AIDS Organisations (2015). HIV statistics in Australia: Women.
Retrieved July 3, 2015, fromhttp://www.afao.org.au/about-hiv/the-hiv-epidemic/hiv-statisticsaustral...
Australian Federation of AIDS Organisations (2014). Having children. Retrieved July 3, 2015,
from http://www.afao.org.au/living-with-hiv/having-children#.VZXxDFJGRCI
British HIV Association. (2012). British HIV Association guidelines for the management of HIV
infection in pregnant women 2012. HIV Medicine, 13 (Suppl. 2), 87157. Retrieved July 21,
2015, fromhttp://www.bhiva.org/documents/Guidelines/Pregnancy/2012/hiv1030_6.pdf
Kent, G. (2005). HIV/AIDS, Infant feeding, and human rights. In W. B Eide & U. Kracht
(Eds.), Food and human rights in development. Volume I. Legal and institutional dimensions and
selected topics pp. 391-424). Antwerp, Belgium: Intersentia.
European Collaborative Study. (1991). Children born to women with HIV-1 infection: natural
history and risk of transmission. The Lancet, 337(8736), 253-260.
Kilewo, C., Karlsson, K., Massawe, A., Lyamuya, E., Swai, A., Mhalu, F., ... & Mitra Study
Team. (2008). Prevention of mother-to-child transmission of HIV-1 through breast-feeding by
treating infants prophylactically with lamivudine in Dar es Salaam, Tanzania: the Mitra
Study. JAIDS, 48(3), 315-323.
Kilewo, C., Karlsson, K., Ngarina, M., Massawe, A., Lyamuya, E., Swai, A., ... & Mitra Plus
Study Team. (2009). Prevention of mother-to-child transmission of HIV-1 through breastfeeding
by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania: the Mitra Plus
study. JAIDS, 52(3), 406416.
Marazzi, M. C., Nielsen-Saines, K., Buonomo, E., Scarcella, P., Germano, P., Majid, N. A., ... &
Palombi, L. (2009). Increased infant human immunodeficiency virus-type one free survival at
one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy
during breast-feeding. The Pediatric Infectious Disease Journal, 28(6), 483487.
Palombi, L., Marazzi, M. C., Voetberg, A., & Magid, N. A. (2007). Treatment acceleration
program and the experience of the DREAM program in prevention of mother-to-child
transmission of HIV. AIDS, 21, S65-S71.
Peltier, C. A., Ndayisaba, G. F., Lepage, P., Van Griensven, J., Leroy, V., Omes, C., ... &
Courteille, O. (2009). Breastfeeding with maternal antiretroviral therapy or formula feeding to
prevent HIV postnatal mother-to-child transmission in Rwanda. AIDS (London,
England), 23(18), 2415.