International Journal of Medicine and

Pharmaceutical Science (IJMPS)

ISSN(P): 2250-0049; ISSN(E): 2321-0095
Vol. 6, Issue 3, Jun 2016, 15-20
TJPRC Pvt. Ltd.

FEEDING OPTIONS AND HIV STATUS OF BABIES WHOSE MOTHERS

WERE ON ANTIRETROVIRAL THERAPY IN UNIVERSITY OF
TECHING HOSPITAL, UYO.NIGERIA
E. M. UMOFFIA1, A. M. ABASIATTAI2, A. E. MOSES3, M. E. UMOFFIA4 & E. BASSEY5
1

Department of Medical Microbiology/Molecular Virology, University of Uyo Teaching Hospital, Nigeria

2,5

Department of Obstetrics and Gynecology, University of Uyo Teaching Hospital, Uyo, Nigeria
3
4

Department of Medical Microbiology, University of Uyo, Nigeria

Department of Peadiatric, University of Uyo Teaching Hospital, Uyo, Nigeria

ABSTRACT
Breast milk has a high nutritional value for normal growth of an infant, but can also be a vehicle of HIV-1
transmission if there is no intervention. The objective of this study was to determine the HIV status of babies of HIV
positive mothers who were on antiretroviral therapy (ART) whose babies were either exclusively breast fed (EBF) on
exclusive breast milk substitute (EBMS).Out of 518 pregnant women screened for HIV at the University of Uyo Teaching

antiretroviral therapy (ART) after laboratory base line investigations, monitored till delivery when their babies were
administered ART within 72 hours of birth and continued till 6 weeks. Their babies HIV status were determined by
qualitative HIV-1 DNA PCR using Amplicore method. Out of 412 surviving babies,161 were exclusively breastfed (EBF)
for 6 months and 251 were exclusively breast fed with breast milk substitutes. Among the 161 babies who were exclusively
breast fed, 9(5.6%) were infected with HIV while 152(94.6%) were HIV negative. Among 251 who were exclusively fed

Original Article

Hospital, Uyo, 418 tested positive and were enrolled into this study following informed consent. They were administered

with breast milk substitutes (EBMS),44(17.5%) were HIV positive while 207(82.5%) were negative. The EBF babies had
less percentage 9(5.6%) of babies infected with HIV hence there is lower risk of HIV infection among babies who were
exclusively breast fed whose mothers were on ART.
KEYWORDS: Breasfeeding, Mother-to-Child Transmission, HIV Status

Received: Feb 23, 2016; Accepted: May 07, 2016; Published: May 11, 2016; Paper Id.: IJMPSJUN201602

INTRODUCTION
A pregnant woman freely shares life-sustaining nutrients with her yet unborn child through her natures
pathways connecting mother and child. Through the same way, an HIV infected mother passes on HIV to her
innocent unborn child.

During delivery, the mothers blood come in direct contact with her baby and there is

tendency for HIV transmission to the baby ( Newell, 2003). Breast-milk is the number one food for the baby. It is
most nutritious and has medicinal properties to protect the child (Lauren,2015). This is not so, if the mother carries
HIV as the virus is transmitted through the breast-milk to the innocent child (Newell, 2003; Filteau, 2003;
Brahmbhatt, et al, 2006; Eke, 2007). In the developed countries, the combined use of antiretroviral drugs, elective
caesarean section, and bottle feeding from birth, has decreased the risk of HIV transmission.

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16

E. M. Umoffia, A. M. Abasiattai, A. E. Moses, M. E. Umoffia & E. Bassey

HIV Transmission and Breastfeeding

Breastfeeding significantly enhances the proportion of infants becoming infected, which is the reason HIVinfected women in industrialized countries, where there is ready access to safe, nutritionally adequate breast-milk
substitutes, are advised not to breastfeed (Filteau, 2003).
Safer Babies Feeding
There are two major infant feeding options available for feeding babies born to HIV positive mothers,
mothers-breastfeeding and replacement feeding. However breastfeeding becomes the only feasible option where the
mothers are very poor and cannot afford replacement feeds (Eke, 2007). Mothers are encouraged to breast feed exclusively
for short periods (3 to 6 months) and should be discontinued abruptly once an alternative form of feeding becomes feasible.
HIV positive nursing mother could make her own breast milk safer for her infant by expressing it and pasteurizing it
(Filteau, 2003; Eke, 2007). Mixed feeding (breast milk with bottle feeding of water or formula, or providing other foods) is
not recommended because studies suggest it carries a higher risk of HIV transmission than exclusive breast-feeding. This
may be because mixed feeding cause irritation that damages the lining of the babys stomach and intestines and thus makes
it easier for HIV in breast milk to infect the baby (Filteau, 2003; Brahmbhatt et al., 2006).
If the mother chooses not to breastfeed and can meet the criteria for replacement feed options, Breast Milk
Substitutes (BMS) that are affordable, feasible, acceptable, sustainable and suitable (AFASS) like commercial infant
formula or home modified animal milk are recommended (Eke,2007).

MATERIALS AND METHODS

This study was conducted on 518 antenatal attendees at the University of Uyo Teaching Hospital (U.U.T.H), Uyo
who were undergoing routine screening to determine their HIV status.There were 418 that tested HIV positive and were
recruited into the study after being informed about the study and those that consented were made to sign a consent form.
Ethical approval for this study was sought and obtained from the ethical committee of U.U.T.H.Structured
questionnaires were used to collect information on demographic and socioeconomical status of the subjects.
The pregnant women were screened for HIV using serial algorithm 2 (FMOH,2007). This method is in line with
World Health Organization (WHO) recommendation.
Serodiagnosis of HIV
The first-line test kit used was Determine HIV-1/2 (Abott, Japan) and the procedure was as described in the kits
manual. Any positive result obtained was repeated with a second line test kit. UniGold (Trinity Biotech, Ireland, UK) and
where positive result was still obtained, the result was recorded as positive. Where there was a discordant result, both tests
were repeated. If discordant result was still obtained, a third line test kit, Stat- Pak HIV-1/2 (Chembio, USA) test kit was
used as a tie breaker. If positive result was obtained, it was recorded as positive but if negative, it was recorded as
negative and a follow-up test was done in one months time.
Those women who were HIV positive were recruited into the study. They were administered antiretroviral
therapies (Nevirapine (NVP), Lamivudine (3TC) and Zidovudine (ZVD) after base line laboratory investigations were
carried out.

Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

Feeding Options and HIV Status of Babies Whose Mothers Were on

Antiretroviral Therapy in University of Teching Hospital, UYO. Nigeria

17

Babies born of the HIV negative mothers were used as controls.

HIV status of babies who were breastfed exclusively for six months and those who were fed with breast milk
substitutes were determined using conventional Polymerase chain reaction (PCR) using the amplicore HIV-1 DNA Test,
version 1.5 (FMOH,2007).The procedure and interpretation of results were carried out as described by the kit
manufacturers.

RESULTS
Demographic Data of HIV Seropositive Pregnant Women
The age distribution of HIV seropositive and seronegative pregnant women are shown in Table 1.The HIV
positive Pregnant women were predominantly in the age range of 21 25 yrs with 155 (37.1%) followed by the age group
of 26- 30 yrs with 126 (30.1%).None of those in the age group 40yr and above had HIV infection.
HIV negative pregnant women were predominantly in the age group of (26 30 years (40.0%) followed by the
age group of 21- 25 years 29(29.0%). There was no significant statistical difference (P > 0.05) in age distribution of HIV
positive and HIV negative pregnant women. (Table 1).
Table 1: Age Distribution of HIV Seropositive and HIV Seronegative Pregnant Women
Number of Subjects
Demographic
Age
group(yr)
< 20
21-25
26-30
31-35
36-40
>40
Total
P- value

HIV Positive
No. (%)

HIV
Negative
No.(%)

11(2.63)
155(37.1)
126(30.1)
71(17.0)
55(13.2)
0(0)
418
2

8(8.0)
29(29.0)
40(40.0)
10(10.0)
8(8.0)
5(5.0)
100
P > 0.05

Table 2 showed the outcome of feeding options of babies whose mothers were on antiretroviral therapy. Out of
412 babies, 161 were exclusively breast fed and 251 were fed exclusively with breast milk substitute. Of those exclusively
breast fed 9(5.6%) had HIV infection while amongst those who were on exclusive breast milk substitute, 44(17.5%) were
HIV positive while 207(82.5%) were HIV negative. There was a significant statistical difference (P < 0.05) between babies
on feeding options that were infected HIV.
Table 2: Outcome of Feeding Options of Babies Whose Mothers Were on Antiretroviral Therapy
Feeding Options

No. of HIV+ve
Women

EBF
161
EBMS
251
Total
412
EBF Exclusive Breast Feeding

No. (%)
HIV+ve
Babies
9(5.9)
44(17.5)
53(12.7)

No. (%) HIV-ve

Babies
152(94.6)
207(82.5)
359(87.1)

EBMS Exclusive Breast Milk Substitute

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E. M. Umoffia, A. M. Abasiattai, A. E. Moses, M. E. Umoffia & E. Bassey

DISCUSSIONS
This study has highlighted important findings among babies of HIV infected mothers who opted for either EBF or
EBMS. Those babies who were exclusively breast fed had higher number of babies 152 (94.4%) who were not infected
with HIV from birth as against 9(5.63%) of infected ones.
This is in accordance with Shapiro, (2005) who opined that infants of HIV infected mothers can still stand risks of
being infected during breastfeeding. It has been reported that when antiretroviral therapy is begun at the third trimester of
pregnancy, it reduces vertical transmission to 2-4% (Shapiro,2005). It has also been documented by FMOH in 2007 that
one to two third of the overall transmission of HIV transmission to babies occur during labour and delivery, depending
whether the mother breastfed or not and that the risk of vertical transmission of HIV is 15-30% if the mother does not
breast feed, the risk is as high as 30-45% if baby is not breast feed (De cock et al, 2000).
On the other hand international guidelines in April, 2005 on AIDS issue as reported by Humphrey recommended
that HIV positive mothers should avoid breast feeding.
They recommended that HIV seropositive mothers who choose to breastfeed should do so exclusively. Their
recommendation to avoid breastfeeding contradicts the results of our study.
In 2006 the World Health Organisation recommended that HIV positive mothers should exclusively breastfeed
their infants for 6 months and then rapidly wean.
In 21 February, 2011, NYANDO nutrition expert in their news recommended that HIV positive mothers should
exclusively breast feed their babies for the first six months.
According to Anthony, 2011 expanding breastfeeding reduces infant mortality in place that does not have safe,
clean water by protecting babies from common childhood diseases because breast milk contains protective antibodies from
the mother that formula feeds do not provide. Findings showed that administering to the infants of HIV positive mothers
antiretroviral therapy daily for the full duration of breast feeding safely minimised the threat of HIV transmission through
breast milk while providing the health benefits of expanding breast feeding (WHO, 2001)

SUMMARY AND CONCLUSIONS

This work showed that formula fed babies had more HIV positive babies 44(17.5%) as against 9(5.6%) who were
fed with breast milk. It can be concluded that HIV positive mothers who were on HAART and breast fed their babies
exclusively for six months had babies with minimal risk of HIV infection. Hence, EBF should therefore be encouraged
among nursing mothers irrespective of their HIV status.
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Brahmbhatt, H.et al. (2006). Mortality in HIV-infected and uninfected children of HIV-infected and uninfected mothers in
rural Uganda. Journal of Acquired Immune Deficiency Syndrome 41:504-508.

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De Cock, K. M. (2000). Prevention to mother-to-child HIV transmission in resource-poor countries: translating research into
policy and practice. Journal of the American Medical Association, 283(9): 1175-1182.

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Eke, C. (2007). HIV and Nutrition in Nigeria. The Challenges. Nigeria World Message Board. Available from:
http://nigeriaworld.com/board/viewtopic.php.Retrieved on 4th March, 2007.

Impact Factor (JCC): 5.4638

NAAS Rating: 3.54

Feeding Options and HIV Status of Babies Whose Mothers Were on

Antiretroviral Therapy in University of Teching Hospital, UYO. Nigeria
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19

Filteau, S. (2003). Reducing childhood mortality in poor countries: infant-feeding strategies to prevent post-natal
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