Aug. 1: Breast feeding by HIV-positive mothers has always been a controversial subject. It is supposed that breast-feeding will lead to transmission of HIV to the infant, but according to the city-based National Institute of Nutrition the child can be exclusively breast-fed for four months to six months provided the mother takes anti-retroviral therapy (ART) from the 14th week of pregnancy.
NIN's guidelines for breast-feeding for HIV affected mothers stipulates that the ART must be continued till the mother ceases to breast feed. The World Health Organisation also recommends that mothers known to be HIV-positive should exclusively breast feed their infants until six months of age and introduce appropriate complementary foods thereafter. World Breast-feeding Week is celebrated every year in the first week of August to encourage breast-feeding. More than 2.4 million children die in India every year and two-thirds of these deaths are related to inappropriate infant feeding practices. Breast milk gives the infant natural immunity and protects it against infections at a time when it own immune system is not very strong. Alternative feeding options such as water can often be contaminated.
NIN concedes that 'HIV may be transmitted from mother to infant through breast milk. However, women living in resource-poor settings in developing countries may not have access to safe, hygienic and affordable replacement feeding options. Considering the important role of breast milk in child growth and development, the National AIDS Control Organisation (NACO) too recommended that HIV-positive mothers can breast feed their babies.' The recommended time to stop breast-feeding is six months. NIN recommends however that the HIV affected mothers should be informed about the risk of transmission of HIV through breast milk and its consequences and should be counselled about the risks and benefits of each feeding method, and helped to select the option best suited to their situation. 'In any case,' NIN warns, 'mixed feeding, that is, breast-feeding along with other feeds, should be strictly discouraged as it increases the risk of HIV transmission.’
NIN says breast-feeding should begin within an hour after delivery. Colostrum (thin yellowish fluid secreted for a few days after delivery) should not be discarded as it contains proteins and antibodies that boost the immune system. Breast-feed exclusively (not even water) for a minimum of six months if the growth of the infant is adequate. Normal women should breast-feed their children frequently and on demand to establish and maintain good milk supply. They should have a nutritionally adequate diet both during pregnancy and lactation and avoid tobacco, alcohol and drugs during lactation.
“So, breast feeding is a good option for every baby including those of HIV-positive mothers when they have access to anti-retroviral therapy (ART). It also reduces the risk of developing breast cancer. However, women receiving chemotherapy should abstain from breast-feeding as it may harm the baby," said Dr P. Raghuram, oncoplastic surgeon, Kims-Ushalakshmi Foundation. Dr Suneetha Narreddy, infectious diseases consultant at Apollo Hospitals, said, "Research has shown that in order to decrease the mother-to-child transmission of HIV, the best modality is to feed babies exclusively by bottle. However, when this was attempted in resource poor settings, it was found that more children were dying of diarrhoea due to improper handling/cleaning of bottles.”
She said it was also found that if children were partially breast-fed and partially bottle-fed, they faired poorly. Children fed exclusively on breast milk did better than those who were fed partially on breast milk. According to Ms Suneetha Sapur, director, Akshaya Foundation, vertical transmission of HIV infection may occur during pregnancy, at delivery and via breast feeding. Avoiding or early cessation of breast-feeding was advised earlier to reduce HIV transmission, but recent clinical research suggests that not breast-feeding the infant may increase child morbidity and mortality and provide no net benefit for HIV-free survival. “Recent guidelines by WHO recommend that HIV infected mothers should exclusively breast-feed their infants for six months, possibly adding anti-retroviral interventions to diminish transmission risk still further,” she said.
