Study: HIV-Positive Moms May Consider Formula

Breast-feeding doesn't reduce rates of disease or death in babies born to HIV-positive mothers, according to a new study.

Thus, perhaps HIV-positive mothers should consider feeding their infants formula to prevent transmission of the virus, researchers wrote.

A two-year follow-up of babies born to HIV-positive women in Nairobi, Kenya, showed no significant difference in death rates or the incidence of pneumonia, diarrhea, and other illnesses among infants who were breast-fed and those who received formula.

The study will be published in Wednesday's issue of The Journal of the American Medical Association.

Dr. Dorothy Mbori-Ngacha of the University of Nairobi, Kenya, and Dr. Joan Kreiss of the University of Washington, Seattle, and colleagues conducted a randomized clinical trial to compare morbidity (the presence of disease or other conditions), nutritional status, mortality (the death rate) adjusted for HIV status, and cause of death between formula-fed babies and breast-fed babies of HIV-infected women.

According to background information cited in the article, breast-feeding among HIV-infected women is associated a risk of transmitting the virus. In a previous report from this study, the authors reported that the use of formula could prevent 44 percent of HIV infections in infants from mothers positive for the virus.

But little is known about the morbidity risks associated with formula feeding in infants of HIV-infected women in resource-poor settings.

Although disease and mortality rates were the same between breast-fed and forumla-fed infants, those who were breast-fed tended to have better nutritional status -- significantly so during the first six months of life.

While cautioning that their results may represent a best-case scenario, and that their estimates of morbidity and mortality risk cannot be generalized to all women in developing countries, the authors asserted that formula feeding provided advantages for mother and child.

"Our current analyses show that 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," the authors wrote.

In an accompanying editorial, Dr. Laura A. Guay and Dr. Andrea J. Ruff of the Johns Hopkins University of School of Medicine in Baltimore noted that the study's findings are interesting, but cannot be generalized, and should be confirmed before influencing public health policy.

They pointed out that providing formula to HIV-infected women is not easily accomplished, and that women may choose to breast-feed for various reasons.

"In communities where breast-feeding is the norm and not breast-feeding may lead to stigmatization and loss of confidentiality in HIV status, making infant formula available will not guarantee its acceptance," the doctors wrote.

Guay and Ruff asserted that withholding breast milk is unlikely to become standard practice among the majority of HIV-positive mothers in sub-Saharan Africa.

"That breast-feeding with all its benefits should also pose a significant risk of HIV transmission is one of the ultimate public health paradoxes and will likely continue to be a major challenge for the prevention of HIV infections in infants living in resource-poor settings," they wrote.