Infant health research

The below studies look at the effects of breastfeeding on HIV transmission

Maternal HIV drug resistance is associated with vertical transmission and is prevalent in infected infants

This study aimed to assess if maternal HIV drug resistance is associated with an increased risk of HIV vertical transmission and to describe the dynamics of drug resistance in HIV-infected infants. An analysis of 85 cases and 255 matched controls indicated that maternal HIV drug resistance and maternal viral load were independent risk factors for vertical transmission during breastfeeding. This suggests that nevirapine alone may be insufficient infant prophylaxis against drug-resistant variants in maternal breastmilk. These findings support efforts to achieve suppression of HIV replication during pregnancy and suggest that breastfeeding infants may benefit from prophylaxis with a greater barrier to drug resistance than nevirapine alone.

Ceejay, B. et al. 2021. For the IMPAACT 1077BF Promoting Maternal and Infant Survival Everywhere (PROMISE) Study Team, Maternal HIV drug resistance is associated with vertical transmission and is prevalent in infected infants, Clinical Infectious Diseases, 2021;, ciab744,

“In the United States, we say, ‘No breastfeeding,’ but that is no longer realistic”: provider perspectives towards infant feeding among women living with HIV in the United States

This study highlights the challenges experienced by health providers and patients in low- and high-resource countries in regards to contrasting recommendations of infant feeding practice by mothers living with HIV. Recommendations in the United States are that mothers living with HIV formula feed their infants, as opposed to the World Health Organization’s recommendation of exclusive breastfeeding with ongoing antiretroviral therapy. This study uses multiple methods to understand providers’ infant feeding perspectives on caring for their pregnant and post-partum WLHIV in the U.S.

Tuthill EL, Tomori C, Van Natta M, Coleman JS. “In the United States, we say, ‘but that is no longer realistic’: provider perspectives towards infant feeding among women living with HIV in the United States. J Int AIDS Soc. 2019 Jan; 22 (1): e25224. doi: 10.1002/jja2.25224. PMID. 30657639; PMCID: PMC6338297. 

WHO/UNICEF, 2016 GUIDELINE – Updates on HIV and infant feeding: The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV

These updates to the 2010 WHO guidelines on HIV and Infant Feeding recommend for the first time the use of antiretroviral drugs to prevent postnatal transmission of HIV through breastfeeding. This resulted in a major change from an individualised counselling approach toward a public health approach regarding how maternal and child health services should routinely promote and support infant feeding practices among mothers living with HIV.

World Health Organization, United Nations Children’s Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2016.

Breastfeeding and HIV Transmission, Coutsoudis 2001 

This study (1) found that babies of HIV-infected mothers who were breastfed exclusively for three months or more were at no greater risk of HIV infection during the first six months than those never breastfed. 551 HIV-infected mothers and their babies were included in the study. Exclusive breastfeeding, defined as a time dependent variable, carried a significantly lower risk of HIV infection than mixed feeding (hazard ratio 0.56, 95% CI 0.32-0.98, p=0.04) and a similar risk to no breastfeeding (HR 1.19, 95% CI 0.63-2.22, p=0.59). The authors suggest that other foods and fluids introduced to the gut of mixed-fed babies damage the bowel and facilitate the entry into the body tissues of the HIV present in these mothers’ breastmilk. This is supported by the finding that, if mothers continued to breastfeed along with other foods once the period of exclusive breastfeeding had ended, new HIV infections began to occur. The investigators call for further research.

See also commentary by the same author (2).

  1. Coutsoudis A et al. (2001) Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS15: 379-87. [Abstract]
  2. Coutsoudis A et al (2002). Free formula milk for infants of HIV-infected women: blessing or curse? Health Policy and Planning17: 154-160. [Abstract]

Breastfeeding and HIV Transmission, Latham 2000

This article acknowledges that appropriate infant feeding options differ according to the circumstances of the mother and baby. It argues that it is appropriate to recommend exclusive breastfeeding for mothers in sub-Saharan Africa.

Latham MC, Preble EA (2000) Appropriate feeding methods for infants of HIV infected mothers in sub-Saharan Africa.BMJ 320: 1656-1660. [Full text]

Breastfeeding and HIV-1 Transmission, Nicoll 2000 

Study on the links between infant feeding and HIV-1 infection.

Nicoll A, Newell ML, Peckham C, Luo C, Savage F (2000) Infant feeding and HIV-1 infection. AIDS 14: Suppl 3: S57-74. [Abstract]

Breastfeeding and HIV-1 Transmission, Coutsoudis 1999 

Babies born to 549 HIV-1-infected South African women were assessed at 3 months of age. After adjustment for potential confounders, exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding (hazard ratio 0.52 [95% CI 0.28-0.98]) and a similar risk to no breastfeeding (0.85 [0.51-1.42]). The authors call for further research but point out that exclusively breastfed babies had a (non-significant) lower probability of infection than those never breastfed and suggest that this may be due to virus acquired during delivery being neutralised by immune factors in breastmilk. They propose that mixed feeding carries the highest risk due to the beneficial immune factors in breastmilk being counteracted by damage to the infant’s gut and disruption of immune barriers caused by contaminants in mixed feeds.

There is an editorial on this subject in the same issue of the Lancet (Newell M-L (1999) Infant feeding and HIV-1 transmission. Lancet 354: 442-3) and correspondence in a subsequent issue (Infant feeding patterns and HIV-1 transmission. Lancet 354: 1901-1904).

Coutsoudis A et al. (1999) Influence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study. Lancet 354: 471-476.

Related research and further reading

The impact of breastfeeding on maternal and child health: Acta Paediatrica special issue

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The Lancet: Increasing breastfeeding worldwide could prevent over 800,000 child deaths every year

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