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Editorial
November 21, 2001

HIV and Infant Feeding—An Ongoing Challenge

Author Affiliations

Author Affiliations: Departments of Pathology (Dr Guay) and Pediatrics (Drs Guay and Ruff), Johns Hopkins University School of Medicine and Department of International Health, Johns Hopkins University Bloomberg School of Public Health (Dr Ruff), Baltimore, Md.

JAMA. 2001;286(19):2462-2464. doi:10.1001/jama.286.19.2462

Recognition that human immunodeficiency virus type 1 (HIV-1) could be transmitted through breastfeeding precipitated a public health dilemma. Long promoted as a means of decreasing infant morbidity and mortality, particularly in resource-poor areas, breastfeeding now posed a potential health hazard. Differences in the risk-benefit ratio associated with breastfeeding ultimately led to 2 sets of public health recommendations. In settings with readily available safe breast milk substitutes and low background infant mortality rates, withholding breastfeeding was not expected to be associated with increased infant mortality rates and thus HIV-infected women were advised not to breastfeed.1 In contrast, in resource-poor settings, withholding breastfeeding was known to significantly increase infant morbidity and mortality due to infectious diseases and malnutrition.25 However, the risk-benefit ratio for an HIV-infected woman was not constant throughout resource-poor settings: some women in such settings might in fact be able to provide safe breast milk alternatives to their infants. This led to the need to assess the risk-benefit ratio on an individual basis.

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