Home            Past Issues            About IP            About IAP           Author Information            Subscription            Advertisement              Search  

   
correspondence

Indian Pediatr 2011;48: 572-573

Reply

Akash Bang and Satish Tiwari

Email: [email protected]
 

  1. Methods such as Pretoria Pasteurization or Flash Heat Treatment can effectively inactivate the virus in breastmilk from HIV-infected mothers [1,2]. These methods can also eliminate potential contaminants and adequately inhibit bacterial growth while retaining nutrients contained in breastmilk [3]. In a developing country set up where thermometer may not be available everywhere, it may be difficult to mention a standardized method, but breastmilk treated in this way is nutritionally adequate to support normal growth and development. However, it is difficult to sustain adhering to this method over a prolonged duration. The role of heat treatment as a truly feasible HIV prevention and child survival strategy is yet not clear [4]. However, this approach (heating to the boiling point) is useful as an ‘interim’ strategy to assist mothers over specific periods of time.
     

  2. The term "Mixed feeding" is generally referred to feeding of breastmilk and other liquid/solids food prior to 6 months of age. It is hypothesized that when these infants are mix fed, the immature gastrointestinal tract is exposed to antigens and pathogens which may cause inflammation and facilitate acquisition of HIV infection [5] Exclusive breastfeeding may be healthier because it protects the integrity of the intestinal mucosa, a barrier to HIV. Another possible mechanism is that mixed feeding results in suboptimal breastfeeding practices which predisposes to mastitis and cracked nipples, consequently increasing the risk of transmission.

After six months the gut is more mature and better able to handle complex proteins and antigens significantly decreasing the risk of transmission. Thus after six months of age, the nutritional benefits of complementary feeding (which may or may not be milk based) and extended breastfeeding till 12 months outweigh the risk of transmission and is probably the best possible strategy for HIV-free survival. This is all the more true if the mother and baby are on antiretroviral prophylaxis or therapy as the new recommendations advocate.

Lastly, we wish to reiterate that on these issues the guidelines are dynamic and changing with the availability of new evidences (like NACO and Newer WHO guidelines). The current guidelines have been proposed keeping the Indian context in mind. We would like to re-emphasize that these guidelines do not provide all of the answers but suggest the general course of action that everyone needs to undertake in our day to day practices to improve child nutrition in the Indian subcontinent.

Acknowledgments: Dr Satinder Aneja and Dr Nidhi Chaudhary (WHO) for data acquisition and drafting of the reply.

References

1. Jeffery BS, Mercer KG. Pretoria pasteurization: a potential method for the reduction of postnatal mother to child transmission of HIV. J Trop Pediatr. 2000;46:219-23.

2. Israel-Ballard KA, Maternowska MC, Abrams BF, Morrison P, Chitibura L, Chipato T, et al. Acceptability of heat treating breastmilk to prevent mother-to-child transmission of HIV in Zimbabwe: a qualitative study. J Hum Lact. 2006;22:48-60.

3. Jeffery BS, Soma-Pillay P, Makin J, Moolman G. The effect of Pretoria pasteurization on bacterial contamination of hand-expressed human breastmilk. J Trop Pediatr. 2003;49:240-4.

4. WHO Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. Available from: http://www.who.int/child_adolescent_health/documents/hiv_aids/en/index.html. Accessed on February 7, 2011.

5. Walker WA, Isselbacher KJ, Bloch KJ. Intestinal uptake of macromolecules: effect of oral immunization. Science. 1972;177:608-10.
 

 

Copyright© 1999 by the Indian Pediatrics (Disclaimer)