Exclusive breast is best for HIV (+) women (3)
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Dear Gregg,
No doubt the Coutsoudis study needs confirmatory studies. They say
that themselves.
I was at the first WHO expert meeting on HIV and breastfeeding in
1987. Then there was no proof that HIV could be transmitted through
breast milk, just a few suggestive case studies. Yet WHO wanted a
statement already then saying that HIV+ women should not breast-feed.
A small group who threatened to write a minority statement forced the
addition of a sentence to the emerging expert statement which said in
effect that in areas where the majority of infant deaths were due to
infection, all mothers should be advised to breast-feed, irrespective
of HIV status. This was repeated in later policy statements and
lasted until the new 1997-98 UNAIDS policy initiative, sparked by the
Thai study on short-course AZT which, interestingly, no one said at
the time required confirmation before leading to such policy changes.
In all the years that have elapsed since 1987, Coutsoudis et al. was
the first prospective study that actually used WHO's own definition
of exclusive breastfeeding (formulated in 1991). Thus the previous
database is fatally flawed. Children receiving anything but breast
milk (even water that may not be clean or contain excess minerals or
other substances), can suffer gut damage that allows HIV more easily
to cross over from breast milk. So while Coutsoudis' study is not
free from flaws, it is the best we have, and in an unbiased world
would now be the major basis for policy making.
My prediction is that in a matter of a few years evidence will be
much clearer that (1) exclusive breastfeeding results in extremely
low transmission of HIV. Since it may reduce some perinatal transmis-
sion, it may result in zero or negative net rates of transmission
compared to not breastfeeding at all. (2) Outcomes among the poor in
Africa who are advised to artificially feed, especially those pro-
vided with free infant formula, will be so poor (death from other
diseases and higher HIV transmission rates because so many will util-
ize the most dangerous option--mixed feeding), that the net result of
the entire new policy initiative is a substantial net loss of life.
Some decades later, when historians can look back more objectively on
what has happened since 1997, the rapid implementation of this new
policy may be viewed as something close to iatrogenic genocide.
Best regards,
Ted Greiner, PhD
Head, International Nutrition Research Group
Department of Women's and Children's Health
Uppsala University Academic Hospital
Entrance 11
751 85 Uppsala, Sweden
Tel: +46-18-611-5937
Fax: +46-18-508-013
mailto:Ted.Greiner@kbh.uu.se
or
mailto:ted_greiner@hotmail.com
Personal website:
http://www.geocities.com/HotSprings/Spa/3156
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