Which feeding option is safer for the HIV exposed infant in sub-Saharan Africa? A critical appraisal of randomized controlled trials.

ABSTRACT

BACKGROUND: Breast milk is a source of optimal nutrition and protection against serious infectious childhood diseases, but carries with it the risk of transmission of the HIV virus to the infant. Therefore, to breast feed or not, remains a dilemma for the HIV positive woman in sub-Saharan Africa. This manuscript critically examines findings from randomized controlled trials to draw evidence available on infant feeding options for HIV exposed infants in sub-Saharan Africa. METHODOLOGY: Primary literature was search on Pub med with the following MeSH terms-"Breastfeeding"; "HIV"; "Infant Formula"; and "sub-Saharan Africa". Randomized Controlled Trials on infant feeding strategies done in sub-Saharan Africa with clinicaltrial.gov registration numbers, published between 2000 and 2009 were eligible for review. The main outcome assessed was postnatal HIV transmission rates, HIV-free survival and infant mortality. RESULTS: A total of 9 randomized controlled trials were assessed for eligibility and 4 fulfilled the inclusion criteria for review. Evidence drawn from the findings of four out of 9 (4/9) randomized controlled trials done in sub-Saharan Africa settings supports breastfeeding as an optimal and safe option for the HIV exposed infant in most settings of sub-Saharan Africa faced with challenges of poor access to clean portable water and other socioeconomic limitations. The various study settings, main outcome measures and the principal findings and conclusions are summarised in table 1. CONCLUSION: The findings from the various randomized controlled trials in this review support the practice of breastfeeding with antiretroviral therapy to the mother as a safer option for the HIV-exposed infant in sub-SaharanAfrica.