THE DURATION OF BREAST-FEEDING BY HIV-1-INFECTED MOTHERS IN DEVELOPING-COUNTRIES - BALANCING BENEFITS AND RISKS

How best to advise mothers infected with human immunodeficiency virus type 1 (HIV-1) in developing countries regarding breastfeeding is an i mportant issue that has generated considerable debate. Previous studie s have addressed this problem by means of mathematical models, but wit hout considering the issue of the duration of breastfeeding. A mathema tical model was developed to compare the age-specific risks of mother- to-child HIV transmission versus the excess mortality due to not breas tfeeding. In this model it is assumed that both the risk of mother-to- child transmission of HIV through breast milk and the relative risk of not breastfeeding do not vary with age. The model indicates that, in HIV-1-seropositive mothers, the decrease in child mortality afforded b y breastfeeding may exceed the risk of mother-to-child HIV-1 transmiss ion only during the first 3-7 months of life. Thereafter the risk of H IV-1 transmission probably exceeds the mortality benefit of breastfeed ing. Experimental studies of counselling HIV-1-infected mothers to lim it their duration of breastfeeding should be considered in the setting of developing countries.