Replacement feeding

For an HIV-infected woman to eliminate completely the risk of HIV transmission through breastfeeding she needs to feed her infant from birth with suitable replacements for breast milk (such as commercial infant formula or home-prepared formula made from modified animal milks). The range of replacement feeding options is described in HIV and infant feeding: A guide for health managers and supervisors. Currently there is little information on the safety and feasibility of using breast-milk substitutes in developing countries.

Several investigators have attempted to use mathematical models to offer guidance to policy-makers in different settings for weighing the relative risks and benefits of breastfeeding and other infant feeding methods in view of the HIV epidemic (Kuhn and Stein, 1997; Hancock et al., 1996; Nagelkerke et al., 1995; Nicoll et al., 1995; Del Fante et al., 1993; Hu et al., 1992; Heyman, 1990). These models are limited by the available data regarding the risks associated with various methods of infant feeding and their inability to consider all the factors that influence decision-making about infant feeding. In particular, although there is much evidence of the benefits of breastfeeding in reducing morbidity and mortality in infants whose mothers are not infected with HIV, currently there is little information regarding the effect of replacement feeding on infant morbidity and mortality for infants whose mothers are HIV-infected.

Where adequate replacement feeding is not possible, mothers may choose among three other strategies to reduce the risk of breast-milk transmission:

· Exclusive breastfeeding followed by early cessation of breastfeeding. Early cessation of breastfeeding may reduce exposure and hence the risk of breast milk transmission, while not eliminating the risk entirely, as the infant remains exposed for the first few months.

· Heat treatment of expressed breast milk

· Wet-nursing by a tested HIV-negative women