Breastfeeding, HIV transmission and infant survival: balancing pros and cons

Purpose of review In industrialized countries avoidance of breastfeeding is among the cornerstones of prevention of mother-to-child transmission of HIV. Breastfeeding carries risk for HIV transmission but improves survival, whereas formula feeding carries zero risk for transmission but increased risk for mortality. We assess whether breastfeeding is a rational and viable option for HIV-infected women in poor environments. Recent findings \ A number of recent studies, mostly from Africa, have provided new data that enable health workers to offer HIV-positive women clear advice on infant feeding appropriate to their individual circumstances. The studies are grouped according to whether the evidence favours one or other feeding type and are considered under the following headings: equivalence of formula feeding and breastfeeding; breastfeeding, HIV disease progression and mortality in mothers; breast superior to formula; breastfeeding for HIV-infected babies; and reducing risk for transmission while breastfeeding. Summary The weight of current evidence favours exclusive breastfeeding for 6 months to prevent mother-to-child HIV transmission for most HIV-infected mothers globally, most of whom live in poor communities; exclusive breastfeeding may also benefit HIV-infected babies. Formula feeding appears to be equivalent to breastfeeding in terms of survival and transmission risk during the first 2 years of life in some settings.