title: Exclusive breast-feeding: does it have the potential to reduce breast-feeding transmission of HIV-1?
abstract: Exclusive breast-feeding is unambiguously the optimal infant feeding practice and is universally promoted in the absence of human immunodeficiency virus (HIV-1). It is associated with reduced morbidity and mortality from diarrheal and respiratory diseases. Recent findings suggest that exclusive breast-feeding may pose less risk of HIV-1 transmission than the more common practice of mixed feeding (i.e., breast-feeding concurrent with the feeding of water, other fluids, and foods), which has important infant feeding policy implications for low-resource settings. This paper reviews the biologic mechanisms associated with exclusive breast-feeding that provide protection against gastrointestinal, respiratory, and atopic diseases, and evaluates the relevance of these mechanisms for HIV-1 transmission. Potential mechanisms include reduction in dietary antigens and enteric pathogens that may maintain integrity of the intestinal mucosal barrier and limit inflammatory responses of the gut mucosa; promotion of beneficial intestinal microflora that may increase resistance to infection and modulate the infant's immune response; alteration in specific antiviral or anti-inflammatory factors in human milk that may modulate maternal hormonal or immunologic status; and maintenance of mammary epithelial integrity that may reduce viral load in breast milk.
authors.affiliation: Gertrude H. Sergievsky Center, Columbia University and Joseph L. Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Smith
authors.forename: L
authors.initials: L
authors.lastname: Kuhn
mesh_terms: D001942:Breast Feeding; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007223:Infant; D007225:Infant Food; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007413:Intestinal Mucosa / Q000276:immunology* / Q000382:microbiology / Q000502:physiology; D007774:Lactation; D008895:Milk, Human / Q000276:immunology* / Q000821:virology; D012307:Risk Factors; D019562:Viral Load