Balancing Maternal and Infant Benefits and the Consequences of Breast‐Feeding in the Developing World during the Era of HIV Infection

The issue of breast-feeding among HIV-infected women in resource-limited settings presents major challenges for maternal and infant health and survival. Not only are there concerns about the possible negative effects of prolonged breast-feeding on maternal health but the need to balance the protective effect of breastfeeding against other competing causes of infant mortality and the low but ongoing risk of infant HIV acquisition via breast milk is a persisting issue. We currently know how to safely and effectively decrease mother-to-child transmission of HIV both prenatally and intrapartum. When optimal prenatal and intrapartum interventions are given to the mother and postpartum prophylaxis is provided to the newborn transmission rates can be reduced to 1%-2%. However in resource-limited settings-- where breast-feeding is the norm--postpartum transmission of HIV-1 via breastfeeding continues to be a major unresolved public health dilemma; HIV-1 transmission via breast milk ranges from ~8%-16% when lactation continues into the second year. In these settings where it is not possible to adequately nourish an infant with replacement feeding infant mortality is significantly increased among infants who are not breastfed. (excerpt)