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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.
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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.
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.