Breastfeeding is the international gold standard for infant feeding, as it is known to reduce the risk of infant morbidity and mortality and foster improvements in child growth and development. However, in the context of HIV, breastfeeding significantly increases the risk of mother-to-child transmission (MTCT) of HIV, and this risk is proportional to the duration of breastfeeding. As a result, the World Health Organization recommends avoidance of breastfeeding among HIV-infected mothers when replacement feeding is acceptable, feasible, affordable, sustainable, and safe. Unfortunately, the adoption of formula feeding is not widespread in developing regions such as sub-Saharan Africa, partly due to its high cost and partly due to the social stigma associated with not breastfeeding. Further, in settings where access to adequate hygienic conditions is limited, formula feeding may lead to increased infant morbidity and mortality. Consequently, breastfeeding continues to account for a substantial proportion of pediatric HIV infections in developing regions of the world. Some observational studies examining the role of nutritional status in vertical HIV transmission found that low serum levels of vitamin A were associated with higher risk of MTCT. However, in two trials in Malawi and South Africa, vitamin A had no significant effect on MTCT, while trials in Tanzania and Zimbabwe found that maternal vitamin A supplementation significantly increased the risk of MTCT of HIV. In Tanzania, maternal multivitamin (vitamins B, C, and E) supplementation reduced the risk of HIV transmission via breastfeeding among women who were nutritionally and immunologically compromised, and had additional health benefits such as a decreased incidence of fetal loss and a reduced rate of maternal disease progression. Overall, there is no evidence to support vitamin A supplementation for HIV-infected pregnant mothers. However, multivitamin supplementation including vitamins B, C, and E is strongly recommended. Further research is warranted to investigate the role of other nutrients in vertical HIV transmission via breastfeeding and overall maternal and infant health among HIV-infected breastfeeding women and their children. In settings where alternatives to breastfeeding are not viable, exclusive breastfeeding is recommended for 6 months for children born to HIV-infected women together with rapid weaning and replacement feeding that is optimal for infant health.

Keywords:
Nutrition, HIV, AIDS, Multivitamins, Breastfeeding
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© 2007 Nestec Ltd., Vevey/S. Karger AG, Basel
2007
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