Feeding mode, intestinal permeability, and neopterin excretion: A longitudinal study in infants of HIV-infected south African women

Exclusive breast feeding has been associated with a lower rate of mother-to -child HIV transmission than breast feeding plus other foods. To obtain fur ther information on biologic outcomes of different feeding modes, we examin ed 272 infants of HIV-infected South African women at ages 1, 6, and 14 wee ks. At each visit information about infant diet and morbidity was collected and infants underwent a lactulose/mannitol dual sugar intestinal permeabil ity test. In a subset of infants, urinary neopterin excretion was measured as an indicator of immune system activation. Infants who had themselves bec ome HIV-infected by 14 weeks had higher (P < .01) intestinal permeability a t 6 and 14 weeks and slightly (.05 < p < .1) higher neopterin excretion at all times than uninfected infants. At I week infants given no breast milk h ad higher (p < .05) intestinal permeability than infants given breast milk exclusively or with other foods. Intestinal permeability in infants fed bre ast milk plus other foods was never increased relative to that of exclusive ly breastfed infants. Feeding mode had no effect on neopterin excretion. Th us, infant HIV infection induces changes in gut permeability and possibly i mmune system activation before clinical symptoms become apparent. The effec ts of feeding mode on infant intestinal permeability or urinary neopterin e xcretion do not explain a possible protective effect of exclusive breast fe eding on mother-to-child transmission of HIV.