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The substitution of infant formula for breast milk to limit HIV vertical transmission

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Les Centres GHESKIO,Port-au-Prince, Haiti and Weill Medical College of Cornell ... Lactarium. Formula. Commercial infant formula. Home made infant formula ... – PowerPoint PPT presentation

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Title: The substitution of infant formula for breast milk to limit HIV vertical transmission


1
The substitution of infant formula for breast
milk to limit HIV vertical transmission
  • Francine Noel, Marie-Marcelle Deschamps, Gyrlande
    Bois,Jerry Bonhomme, Larrissa Jean-Baptiste, Jean
    W. Pape
  • Les Centres GHESKIO,Port-au-Prince, Haiti and
    Weill Medical College of Cornell University,New
    York, USA
  • Sponsored by UNICEF, UNFPA, Elizabeth Glaser
    Foundation

2
Timing of HIV vertical transmission
Early Prenatal (lt36 wks)
Late Postpartum (6-24 months)
Early Postpartum (0-6 months)
Labor and Delivery
Late Prenatal (36 wks to labor)
5-10
10-20
10-20
Adapted from N Shaffer, CDC
3
Feeding options recommended by WHO (2003)
  • Breast-feeding
  • Exclusive Breastfeeding
  • Early weaning
  • Heat Treatment
  • Wet-nursing
  • Lactarium
  • Formula
  • Commercial infant formula
  • Home made infant formula
  • Regular meal enriched with milk supplement after
    6 months

4
Issues
  • In resource limited countries, if it were
    possible to provide information regarding infant
    feeding to an HIV-infected mother, the choice of
    formula was impractical for economical reasons
  • Many questions still remain on the outcome of
    children born to HIV-infected mothers who were
    formula fed.

5
Breast feeding-Advantages
  • Bond between mother and infant (affective)
  • Transmission of protective antibodies from mother
    to infant
  • Prevention of respiratory diseases
  • Prevention of diarrheal illnesses
  • Economic
  • Decreased frequency of pregnancies

6
HIV transmission through B/F
  • Duration of breast-feeding
  • 0-6 months5
  • 0-12 months9
  • 0-24 months14
  • Mixed diet (breast feeding exclusively, 25, vs
    mixed diet, 36, at 15 months)
  • Clinical status of the mother (primary HIV
    infection,clinical advanced disease)

Francine Noël, MD
7
Background
  • 60 of the cases of HIV reported in the Caribbean
    are found in Haiti
  • HIV prevalence of 4-13 in women visiting
    pre-natal clinics (2000)
  • Number of births to HIV() mothers per
    year11,700
  • Rate of vertical transmission estimated to be 30

8
Background (continued)
  • Infant mortality rate in non-infected
    children80/1000 (Emmus 2000)
  • 60 of HIV-infected children die within a year of
    age (GHESKIO)

9
GHESKIO s experience-1999
  • National protocol
  • Number of hospitalizations and causes
  • Mother
  • -Prenatal care
  • -AZT 300 mg bid from 36 weeks of gestation
  • -AZT 300 mg every 3 hours during labor
  • Newborn
  • -AZT 2mg/kg / 6 hours for 1 week
  • Medical follow-up
  • Provision of formula for 9 months

10
Formula-Implications
  • 300 US salary per capita
  • Average cost of 32 per child per month (288 for
    9 months)
  • Cultural impact
  • Stigmatization
  • Logistic limitation potable water available for
    41 of the population
  • Morbidity and mortality associated with an
    increase of diarrheal disease

11
Breast feeding situation in Haiti
  • B/F in HIV() mothers varies
  • B/F in HIV(-) mothers 98 initiate and 56 at
    12-23 months
  • Mixed diet in HIV(-) mothers 70 by 3 months of
    age

12
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13
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15
DATA
  • Demographic data
  • Weight at birth, 3, 6, 9, 10 months
  • Number of episodes of diarrhea per child per
    month and causes
  • Number of deaths and causes
  • HIV status

16
ResultsMarch, 1999-December, 2002
  • 203 enrolled
  • -4 breast-fed exclusively
  • -25 had a mixed diet
  • -172 formula-fed
  • (Two children died before being fed)
  • -Episodes of diarrhea/child/month in breast-fed
    group.69(p0.051)
  • -Episodes of diarrhea/child/month in formula-fed
    group.49(p0.051)

17
Weight curve
18
Results-continued
  • -24 deaths-4/29(14) were breast-fed
  • -20/172(12) were formula -fed
  • Mean age of death221 days for the breast-fed
    group vs 108 days in formula-fed group, p0.164

19
Social impact of formula use
  • Medical community
  • Mothers and community

20
Conclusions
  • Results support evidence that provision of
    formula is effective even in a limited resource
    setting
  • Formula provision should be free of charge
  • Counseling and continuous education of care
    givers are mandatory
  • Formula provision is part of GHESKIO s protocol
    with additional protein supplements after
    interruption of provision

21
Conclusions
  • Other studies should look at
  • further reduction of vertical transmission using
    simpler and non-resistant protocol
  • - allowing breastfeeding when mothers are on HAART

22
Acknowledgement
  • HIV Infected mothers followed at GHESKIO
  • MTCT team at GHESKIO
  • SponsorsMOH, UNICEF, UNAIDS, Elizabeth Glaser
    foundation
  • Vanderbilt University, Cornell University

23
MESI ANPIL
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