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标题：Modeling the Effects of Different Infant Feeding Strategies on Infant Survival and Mother-to-Child Transmission of HIV
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作者：Jay S. Ross ; Miriam H. Labbok
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：7
页码：1174-1180
语种：English
出版社：American Public Health Association
摘要：Objectives. We investigated how, under various conditions, the risk of mother-to-child transmission of HIV through breastfeeding compares with the risk of death from artificial feeding. Methods. We developed a spreadsheet simulation model to predict HIV-free survival during 7 age intervals from 0 to 24 months for 5 different infant feeding scenarios in resource-poor settings. Results. Compared with artificial feeding, breastfeeding during the first 6 months by HIV-positive mothers increases HIV-free survival by 32 per 1000 live births. After 6 months, as the age-specific mortality rate and risk of death caused by replacement feeding both decline, replacement feeding appears to be safer. Conclusions. Under conditions common in countries with high HIV prevalence, replacement feeding by HIV-infected mothers should not be generally encouraged until after the infant is approximately 6 months old. Each year, HIV infects an estimated 800 000 children, mainly because of transmission from mother to child during pregnancy, delivery, or breastfeeding. Most of these infections could be prevented through the use of antiretroviral drugs taken during pregnancy and delivery and the avoidance of breastfeeding. However, the use of breastmilk substitutes also brings mortality risks that need to be balanced against the risk of HIV transmission. The balance of risks depends on local conditions and should be examined for each situation. For the mother who is HIV-negative or who does not know her status, breastfeeding continues to be recommended. 1 For the mother who knows she is infected and for the health worker advising her, the risks associated with different infant feeding strategies need to be understood. United Nations agencies currently recommend that: “When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoidance of all breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life.” 2(p32) They also note that the appropriate time to wean depends on both the individual woman’s situation and the continuing risks of replacement feeding (including malnutrition and infections other than HIV) and must take into account the possible increased risk of HIV transmission with mixed feeding during the transition period between exclusive breastfeeding and complete cessation of breastfeeding. Health services worldwide are developing and implementing programs to reduce mother-to-child transmission (MTCT) of HIV, including antiretroviral therapy and artificial feeding. These initiatives increase the urgency of efforts to understand the overall mortality risks associated with different infant feeding strategies under different conditions. A number of studies have been published that use simulation models to answer such questions. 3– 11 These simulations unanimously conclude that under conditions of high infant mortality and a high risk of death from replacement feeding, breastfeeding is the safer infant feeding strategy, despite the risk of HIV transmission. Although many of the factors affecting the risks of HIV transmission through breastfeeding and infant mortality vary dramatically with age, most of these analyses treat the whole of infancy as a single homogeneous period. The exceptions 8, 9 lack empirical data on the age-specific risk of death from artificial feeding that are now available. 12 We developed a simulation model that takes into account such age-related changes to estimate the effect on HIV-free survival at different ages of a range of infant feeding strategies, including efforts to make breastfeeding safer.