Risk of Human Immunodeficiency Virus Type-1 Transmission Through Breastfeeding

Dunn, D

doi:10.1097/00006454-199303000-00031

Cited by 24 publications

(29 citation statements)

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“…Millions of children have now been infected with HIV, most of them live in Sub-Saharan Africa (Newell, 1999). Transmission can be attributed in about equal proportions to infection in utero, during delivery or from breast milk, although the relative contribution of each of the opportunities for infection varies considerably (Dunn et al 1992;Bertolli et al 1996).…”

Section: Breast-feedingmentioning

confidence: 99%

“…Although it is estimated that about one-third of cases of paediatric HIV globally contract their infection from breast milk, these numbers vary considerably from country-tocountry. A meta-analysis (Dunn et al 1992) showed that transmission was much higher (29 %) if the HIV infection was acquired during lactation than if the mother was already HIV-positive during pregnancy (15 %). An important factor contributing to the transmission rate is the duration of breast-feeding; if breast-feeding is of long duration then the risk of transmission is higher.…”

Section: Breast-feedingmentioning

confidence: 99%

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Malnutrition, morbidity and mortality in children and their mothers

Tomkins

2000

Proc. Nutr. Soc.

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While being underweight or stunted is recognized as an important risk factor for increased prevalence and severity of infection and high mortality rates, there is increasing evidence for an independent role for micronutrient deficiency. Improving vitamin A status reduces mortality among older infants and young children and reduces pregnancy-related mortality; it also reduces the prevalence of severe illness and clinic attendance among children. Improving Zn status reduces morbidity from diarrhoeal and respiratory infection. Treatment of established infection with vitamin A is effective in measles-associated complications, but is not as useful in the majority of diarrhoeal or respiratory syndromes. Zn supplements, however, have significant benefit on the clinical outcome of diarrhoeal and respiratory infections. Concerns that Fe supplements might increase morbidity if given in malarious populations appear to be decreasing, in the light of new studies on Fe supplements showing improved haemoglobin without an increase in morbidity. Breast-feeding, well known to protect against diarrhoea, is also important in protecting against respiratory infection, especially in the young infant. Transmission of human immunodeficiency virus (HIV) in breast milk is recognized, but new data showing reduced transmission in infants who receive exclusive breast-feeding rather than mixed feeding reinforces the importance of promoting this practice in areas where environmental contamination precludes the safe use of other infant feeding regimens. The presence of subclinical mastitis, now recognized to occur in approximately 20 % of mothers in several developing countries, has been shown to increase the concentration of HIV in breast milk. Preliminary findings suggest that the prevalence of subclinical mastitis is reduced by dietary supplements containing antioxidants. Governments and international agencies now have a strong scientific basis to be much more active and innovative in the introduction of focused nutrition interventions especially micronutrients, for the control of infection.

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Section: Breast-feedingmentioning

confidence: 99%

Section: Breast-feedingmentioning

confidence: 99%

Malnutrition, morbidity and mortality in children and their mothers

Tomkins

2000

Proc. Nutr. Soc.

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“…The HIV epidemic in Africa, where breast-feeding is crucial to child survival, has intensified research in this area. Prolonged breast-feeding may be advisable for most mothers, but among HIV-infected mothers prolonged breast-feeding increases the risk of breast-milk transmission of HIV to the infant, particularly if the mother first becomes HIV-infected while lactating (Dunn et al 1992). Even if the infant itself escapes HIV infection, it may grow up in a family where the adults are too ill and stressed to be maximally economically productive or involved in child care, or where family resources are depleted by medical expenses.…”

Section: Human Immunodeficiency Virusmentioning

confidence: 99%

Role of breast-feeding in managing malnutrition and infectious disease

Filteau

2000

Proc. Nutr. Soc.

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Breast-feeding policy tends to be an emotive issue. International agencies recommend exclusive breast-feeding for 4–6 months followed by continued partial breast-feeding into the second year of life in order to promote infant and child health and minimize the damage caused by the malnutrition–infection cycle. To what extent are these recommendations supported by the experimental evidence? Are they a simplification for emotional reasons or public health purposes? Breast-feeding is believed to benefit infants because breast milk contains the ideal mix of nutrients for infants, because it contains factors which promote development of the infant’s gut and immune system and which prevent pathogen invasion, and because exclusive breast-feeding prevents intake of pathogens in food or water. However, some apparently contradictory evidence exists. First, in environments which are not highly contaminated breast-fed infants tend to growth falter relative to those fed formula. Second, in such environments partial breast-feeding is not associated with significantly increased gut damage relative to exclusive breast-feeding, suggesting that active promotion of gut development by breast-feeding is more important than simple avoidance of pathogens from other foods. Third, many immune factors in breast milk are probably present primarily to protect the mother, not the infant. Finally, breast milk itself may contain bacteria or viruses. This problem has come to the fore with the human immunodeficiency virus epidemic, since it is clear breast-feeding is an important mode of mother-to-child transmission. The present review will examine these challenges to the basis of the international infant feeding recommendations and will suggest that the science does actually support the policy.

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“…This salivary defense appears to explain the rarity of casual HIV transmission orally. However, the normally effective oral barrier can be overcome by the solutes in seminal fluid, milk, and colostrums (Mayer and DeGruttola, 1987;Lifson et al, 1990;Quatro et al, 1990;Lane et al, 1991;Ryder et al, 1991;Dunn et al, 1992;Keet et al, 1992;Bertolli et al, 1996;Black, 1996;Berrey and Shea, 1997;Cao et al, 1997).…”

Section: O6er6iew Of the Innate Sali6ary Defense Against Hivmentioning

confidence: 99%

“…Thus, hypotonic disruption appears to be a major mechanism by which saliva kills the transmitting mononuclear leukocytes and thereby prevents their attachment to mucosal epithelial cells and their production of infectious HIV. Unexplained, however, was the paradox that oral transmission of HIV does occur epidemiologically if infected seminal fluid (Mayer and De-Gruttola, 1987;Lifson et al, 1990;Quatro et al, 1990;Lane et al, 1991;Keet et al, 1992;Berrey and Shea, 1997) or milk (Ryder et al, 1991;Dunn et al, 1992;Bertolli et al, 1996;Black, 1996;Cao et al, 1997) is deposited orally, despite the presence of saliva. The mechanisms by which the carrier's seminal fluid or milk may overcome protection by the recipient's saliva was studied .…”

Section: Innate Sali6ary Inhibitorsmentioning

confidence: 99%

Innate antiviral defenses in body fluids and tissues

et al. 2000

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Innate, non-specific, resistance mechanisms are important barriers to pathogens, particularly delaying virus multiplication at the onset of infections. These innate defense mechanisms include a series of mechanical barriers, pre-existing inhibitory molecules, and cellular responses with antimicrobial activity. The antiviral activities of these innate inhibitors reside in a variety of partly characterized substances. This review presents the innate antiviral inhibitors in cell cultures, urine, serum, the gastrointestinal tract, the nervous system, tissues of crustaceans, and saliva. Medical adaptation of the innate antiviral defense mechanisms may be useful for prevention and treatment of viral infections.

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Risk of Human Immunodeficiency Virus Type-1 Transmission Through Breastfeeding

Cited by 24 publications

References 0 publications

Malnutrition, morbidity and mortality in children and their mothers

Malnutrition, morbidity and mortality in children and their mothers

Role of breast-feeding in managing malnutrition and infectious disease

Innate antiviral defenses in body fluids and tissues

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