Knowledge and Practice of Prechewing/Prewarming Food by HIV-Infected Women

Abstract

OBJECTIVE: HIV transmission has been associated with offering a child food prechewed by an HIV-infected caregiver. We assessed awareness of prechewing and oral prewarming of food by an adult before offering it to a child among HIV-infected pregnant women and clinical investigators in 3 Latin American countries. METHODS: HIV-infected pregnant women at 12 sites (Eunice Kennedy Shriver National Institute of Child Health and Human Development International Site Development Initiative Perinatal Longitudinal Study in Latin American Countries, a prospective cohort trial) in Argentina, Brazil, and Peru were administered a screening survey about prechewing/prewarming of infant foods and cautioned against these feeding practices. Survey responses were analyzed, overall, and stratified according to country. RESULTS: Of the 401 HIV-infected pregnant women interviewed, 34% had heard about prechewing (50% from Argentina, 32% from Brazil, and 36% from Peru), 23% knew someone who prechewed food for infants, and 4% had prechewed food in the past. Seventeen percent had heard about oral prewarming of food, 13% knew someone who prewarmed food for infants, and 3% had prewarmed food for an infant in the past. Women who reported knowing someone who prechewed were more likely to also know someone who prewarmed food (P < .0001). Few site investigators anticipated that their patients would be aware of these practices. CONCLUSIONS: Prechewing food, a potential risk factor for HIV transmission, and orally prewarming food, which has not been associated with HIV transmission but might expose a child to blood from an HIV-infected adult, are not uncommon practices in Latin America. Both practices should be further investigated. Site investigator responses underscore that health care providers could be missing information about cultural practices that patients may not report unless specifically asked.

Unusual erythematous plaque with white scales, a case of acquired syphilis in a child and literature review

“…In addition to syphilis, administration of pre-chewed food can also serve as transmission routes for HIV [ 22 , 23 ] and streptococcal pharyngitis [ 24 ]. In many countries, particularly in developing countries, the administration of pre-chewed food to infants is a custom and often occurs within older generations and individuals with low education levels.…”

Syphilis in an Infant Acquired by Mouth‐to‐Mouth Transfer of Prechewed Food

“…It has been reported that prechewing of food is associated with the spread of other infections, including Streptococcus in the United States. More recently, prechewed food is believed to be a way of transmitting HIV . Prechewing food for a child is a rare cause of the transmission of syphilis and was recognized by Hofmann in 1998 and Zhou in 2009 .…”

Prechewing and Prewarming Food for HIV-Exposed Children: A Prospective Cohort Experience from Latin America

“…Maternal viral load was high ( > 10,000 copies/mL) or CD4 count low ( < 350 cells/mm 3 ) around the time of the prechewed/prewarmed feedings in four instances. Three women were not on antiretroviral medications, and one was on a boosted lopinavir-based regimen.…”

“…[2][3][4][5][6] Martiz and colleagues 6 from South Africa reported that markers of disrupted oral mucosal integrity and presence of blood in the mouth were frequently seen in the person who prechews and the child who receives prechewed food.…”

“…3 As with other interventions that seek to change culturally reinforced behaviors such as breastfeeding, multiple interventions including more effective counseling strategies, using peer counselors or lay community workers, and reinforcement of the message by an interdisciplinary group of healthcare providers, might be required to direct caretakers to alternative safe, feasible, feeding practices. [8][9][10] Ivy and colleagues, 2,5 in a case-control study, described the risk of HIV transmission related to an infected adult who prechews food.…”