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    Peer Reviewed

    When is replacement feeding safe for infants of HIV-infected women?

    John-Stewart GC

    PLoS Medicine. 2007 Jan; 4(1):e30.

    In this issue of PLoS Medicine, Renaud Becquet and colleagues report their findings from a new study looking at the long-term safety of infant feeding interventions aimed at reducing mother-to-child HIV transmission in Africa. Over two years, the researchers studied the safety of infant feeding interventions (either formula feeding or shortened breastfeeding) among infants of HIV-infected mothers in Abidjan, Côte d'Ivoire. The authors chose to examine this issue because of the continued challenges faced by HIV-infected mothers regarding infant feeding. Breastmilk transmission of HIV contributes substantially to the risk of infant HIV infection; consequently HIV-infected mothers in Europe and the United States are counseled not to breast-feed their infants. However, avoiding breastfeeding or shortening the term of breast-feeding may be risky for infants in settings with inadequate sanitation, limited access to breast-milk substitutes, or unsafe water. Thus, UNAIDS (the Joint United Nations Programme on HIV/AIDS) recommends that HIV-infected women "replacement feed" their infants when it is acceptable, feasible, affordable, sustainable, and safe ("replacement feeding" is a term used to refer to feeding infants with milk other than breast milk, such as formula). (excerpt)
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