How can mothers with HIV breastfeed safely? Lessons from the saris of Bangladesh

Kids who breastfed for at least six months had higher IQ's in later life, according to a recent article in JAMA Peds.  

But US mothers with HIV are taught not to breastfeed their babies for fear they will transmit HIV. The HIV transmission risk to babies from breastfeeding is ~15%.

That means HIV-infected mothers in the US must choose between higher baby IQ's, and a host of other health benefits of breastfeeding, or safety. 


The breastfeeding choice is even more complicated for mothers with HIV in the developing world. There, in countries with unsafe drinking water, HIV isn't the only threat to babies: diarrheal illness is a major pediatric killer. As a result, feeding babies with formula risks infections that can kill in days instead of years like HIV. 

As a result, breastfeeding recommendations in the US and the developed world are the opposite of those in the developing world:

(1) in the US and the developed world mothers with HIV are taught to use formula and avoid breastfeeding; whereas 

(2) in developing countries mothers breastfeed and hope for HIV therapy to reduce the risk of transmission. In the new consolidated WHO treatment guidelines released 30 June 2013, universal HIV treatment is recommended for pregnant and breastfeeding mothers.

This means that a great way to prevent HIV transmission in the developing world is to make drinking water safer. 

But wait, it gets more complicated. A new UNC study has confirmed that breast milk  actually protects from oral transmission of HIV. That means it is the HIV within breast milk that endangers babies, not the breastmilk itself.

If breast milk protects from oral HIV transmission, and has myriad health benefits, then perhaps we can find a way to remove HIV from breast milk? The solution will need to be low tech since the greatest need is in developing countries - no $83,000 NASA filters, please. 

That's where Rita Colwell comes in. A microbiologist at the University of Maryland, and former head of the National Science Foundation, Colwell studied cholera - a diarrheal disease transmitted by contaminated water - in Bangladesh. She showed that water filtered through a folded sari was far less likely to transmit cholera, meaning families could filter drinking water through a cheap piece of clothing and keep themselves safe.  


Might developing world mothers with HIV use the same trick to protect their babies from HIV? An effective filter for drinking water in the developing world could not only prevent pediatric diarrheal disease, sure, but what if it could prevent HIV transmission. 

What? "Filter breastmilk?" you say. Not so crazy after all -  many investigators are studying creative ways of making breast milk safer by nipple shields and other ingenious ways of filtering HIV out of breast milk.  

Over 1,000 children are infected with HIV every day; let's hope we find an answer soon.

Posted on July 29, 2013 .