The Associated Press - March 1, 2000
Lindsey Tanner, Associated Press Writer

The authors, led by researcher Ruth Nduati in Nairobi, studied 401 HIV-infected women and their infants in Kenya. Their findings appear in today's Journal of the American Medical Association.

The mothers were randomly assigned to breast-feed or to use formula. The authors found that formula use prevented 44 percent of infant infections.

The frequency of breast-milk transmission of the virus was estimated at 16 percent, though the authors said the rate was likely higher since more than one-fourth of the women in the formula group admitted they also breast-fed their infants.

United Nations' figures show that 590,000 infants got HIV from their mothers in 1998, 90 percent of them in Africa. The study's findings suggest that if infected mothers used formula instead, that number would fall to about 260,000.

Like previous research, the study found indications that the biggest risk for transmission occurs in the early weeks of breast-feeding.

Younger infants might have more immature immune systems, and, the researchers noted, exposure to infected milk "diminishes as weaning foods are introduced and milk intake declines."

While breast-feeding was clearly linked to HIV infection, both the formula and breast-feeding groups had similar death rates at 2 years - about 20 percent.

That finding illustrates one of the drawbacks of formula-feeding in developing countries, where tainted water can cause fatal diarrhea in infants and breast-feeding is more affordable and culturally accepted.

The federal Centers for Disease Control and Prevention recommends that infants of HIV-infected women not be breast-fed, a standard adopted in the industrialized world. But the World Health Organization has said that even HIV-positive mothers should breast-feed in areas where infectious disease and malnutrition are leading causes of infant mortality, the authors noted.

United Nations guidelines suggest that infected women in developing areas be told of the risks and benefits of breast-feeding, and the authors say their findings will help such women make better choices.

"Now that we have a good estimate of the risk, our goal should be to put knowledge into practice," said Dr. Joan Kreiss, a co-author and infectious disease specialist at the University of Washington.

A CDC report in the same issue of the journal said better understanding of the timing of HIV transmission related to breast-feeding is needed to determine the best way to prevent infection in children. The authors note that previous research has suggested that breast-feeding exclusively may be less risky than alternating breast-feeding with formula in very young infants.

"Exclusive breast-feeding followed by early weaning" is among prevention strategies that need further research, the authors said.
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