Breastfeeding in the spotlight

A case where an aunt infected her niece with HIV through breastfeeding has drawn attention to feeding practices in South Africa. The case was published in the medical journal Lancet and highlighted the risk of HIV transmission from a surrogate carer, the Africa Centre for Health and Population Studies said today.

A mother in Bloemfontein presented to the hospital a 74-day-old infant infected with HIV, while she had a negative status. It was initially suspected to be a hospital transmission.

However, when social workers intervened, the mother confirmed that her sister had breastfed the baby intermittently from six weeks of age. Doctors and social workers found that the aunt and her five-month-old child were HIV-positive.

The case supported the scenario of surrogate transmission between the aunt and her niece, the organisation said. "This case highlights the need for safe and appropriate infant feeding practices in Africa, including HIV testing of all breastfeeding surrogates and mothers," it said.

The organisation said transmission of the HIV virus to infants was important in South Africa because of government's decision to halt the provision of formula feeds at public health facilities. It said the policy was backed by the expanded use of antiretroviral (ARV) drugs and a recent decrease of mother-to-child HIV transmission in the country.

"In that case, we used similar DNA analysis techniques to support the scenario of nosocomial (hospital-acquired) based HIV transmission."

South Africa had one of the highest rates of HIV/Aids infection and one of the lowest exclusive breastfeeding rates in the word, where fewer than 10% of infants were exclusively breastfeed. "The aunt breastfed the infant out of great kindness so the mother could go back to work. However, this ended up as a tragedy," said Tulio de Oliveira, a senior researcher at the centre.

De Oliveira said he got involved because his previous work on the DNA analysis of HIV in a hospital infection case in Libya. In the Libyan case, 418 infants were infected in Al-Fateh hospital, he said.

"In that case, we used similar DNA analysis techniques to support the scenario of nosocomial (hospital-acquired) based HIV transmission."

He said the case had also been used to prove the innocence of medical personnel, who were accused of deliberately infecting children with HIV. "In the current case... we could clearly show that the virus infecting the aunt, cousin and infant was linked.

"This and other evidence ruled out the nosocomial transmission scenario," said De Oliveira. He said the South African case highlighted the potential role of surrogate breastfeeding in the transmission of HIV.

"South Africa will have to work hard to ensure that public health facilities can identify the HIV status of all mothers and surrogate feeders, and make sure that the HIV-exposed infant starts ARVs as soon as possible," he said.

The Africa Centre for Health and Population Studies is based at the University of KwaZulu-Natal.

News date: 2012-08-16


Publication cited

Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study. Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L For IeDEA-SA, PLoS Medicine (2012), 9(9):e1001304.

KRISP has been created by the coordinated effort of the University of KwaZulu-Natal (UKZN), the Technology Innovation Agency (TIA) and the South African Medical Research Countil (SAMRC).

Location: K-RITH Tower Building
Nelson R Mandela School of Medicine, UKZN
719 Umbilo Road, Durban, South Africa.
Director: Prof. Tulio de Oliveira