Effect of Formula Feeding and Breastfeeding on Child Growth, Infant Mortality, and HIV Transmission in Children Born to HIV-Infected Pregnant Women Who Received Triple Antiretroviral Therapy in a Resource-Limited Setting: Data from an HIV Cohort Study in India
We describe a programme for the prevention of mother-to-child transmission (PMTCT) of HIV that provided universal antiretroviral therapy (ART) to all pregnant women regardless of the CD4 lymphocyte count and formula feeding for children with high risk of HIV transmission through breastfeeding in a district of India. The overall rate of HIV transmission was 3.7%. Although breastfeeding added a 3.1% additional risk of HIV acquisition, formula-fed infants had significantly higher risk of death compared to breastfed infants. The cumulative 12-month mortality was 9.6% for formula-fed infants versus 0.68% for breastfed infants. Anthropometric markers (weight, length/height, weight for length/height, body mass index, head circumference, mid-upper arm circumference, triceps skinfold, and subscapular skinfold) showed that formula-fed infants experience severe malnutrition during the first two months of life. We did not observe any death after rapid weaning at 5-6 months in breastfed infants. The higher-free-of HIV survival in breastfed infants and the low rate of HIV transmission found in this study support the implementation of PMTCT programmes with universal ART to all HIV-infected pregnant women and breastfeeding in order to reduce HIV transmission without increasing infant mortality in developing countries. 1. Background In 2010, there were 1,490,000 HIV-infected pregnant women and 390,000 children became infected with HIV [1]. Mother-to-child transmission of HIV can occur during pregnancy, during birth, or during breastfeeding. The risk of transmission is 15–30% in nonbreastfeeding populations and breastfeeding adds an additional 5–20% risk for an overall transmission rate of 20？45% [2]. In 2010, the World Health Organization (WHO) released the guidelines on antiretroviral drugs for treating pregnant women and preventing HIV infection in infants with the goal of reducing mother-to-child transmission to less than 5% and virtually eliminating HIV infection in children by 2015 [3, 4]. Infant feeding by HIV-infected women remains a public health dilemma for developing countries. Although breastfeeding involves a considerable risk of HIV transmission, nonbreastfed infants are exposed to higher risk of death in resource-limited setting [5, 6]. According to 2010 WHO guidelines [4], National health authorities should decide whether health services will principally counsel and support HIV-infected women to either breastfeed and receive antiretroviral interventions or avoid breastfeeding, as the strategy that will most likely give infants the greatest chance of
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