100% prevention of mother-to-child HIV transmission (2)
-------------------------------------------------------
Thanks to Francisco Mingorance's message about recent research on this
topic. I am sure that many people will be concerned about the "side-
effects" of introducing breast-milk substitutes to poor countries on
the back of the proposed HIV prevention initiative (see posting by
Dr.Erik van Praag last month of a draft press release from WHO/HIV/
UNAIDS) Clearly there is a strong case for antenatal anti-retroviral
therapy for pregnant women who are HIV positive. The concern is that
the widespread availability of breast-milk substitutes will lead to a
much larger mortality and morbidity as a result of gastro-enteritis due
to artificial feeding than the lives that will be saved by interrupting
mother to child transmission of HIV.
It is difficult to predict the balance of risk as there are a number of
unpredictable factors - How many women who think they may be HIV posi-
tive and do not wish to be tested will opt not to breast-feed and
therefore put their infants at far greater risk from gastroenteritis
etc? Will artificial feeding carry a stigma associated with HIV posi-
tivity? My guess is that discouraging breast-feeding will do more harm
than good and that the infant formula countries must be delighted that
they have finally found a "legitimate" way to break into markets which
have steadfastly upheld the international code.
I am not an epidemiologist and realise that the above are "gut feel-
ings". I will be interested to know what others think about this issue.
David Cundall
Community Paediatrician,
Belmont House, Belmont Grove,
Leeds, LS2 9NP, UK
Tel: +44-113-392-6220
Fax: +44-113-392-6219
mailto:cundal@globalnet.co.uk
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