SidaSubSaharaV1, Istex, Corpus, bibRecord, 005272

Safe Water and HIV-Exposed Infants

Identifieur interne : 005272 ( Istex/Corpus ); précédent : 005271; suivant : 005273

Safe Water and HIV-Exposed Infants

Auteurs : Rachel Peletz ; Suzanne Filteau

Source :

The Journal of Infectious Diseases [ 0022-1899 ] ; 2010-05-01.

RBID : ISTEX:FE878608D7B18899B0BA11C2491763004D1A745A
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https://api.istex.fr/document/FE878608D7B18899B0BA11C2491763004D1A745A/fulltext/pdf

DOI: 10.1086/651698

Links to Exploration step

ISTEX:FE878608D7B18899B0BA11C2491763004D1A745A

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<journal-title>The Journal of Infectious Diseases</journal-title>

<abbrev-journal-title>The Journal of Infectious Diseases</abbrev-journal-title>

<issn pub-type="ppub">0022-1899</issn>

<issn pub-type="epub">1537-6613</issn>

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<subj-group subj-group-type="heading">

<subject>Letter to the Editor</subject>

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<title-group>

<article-title>Safe Water and HIV-Exposed Infants</article-title>

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<contrib-group>

<contrib contrib-type="author" corresp="yes">

<name><surname>Peletz</surname>
<given-names>Rachel</given-names>
</name>

<xref rid="aff1" ref-type="aff">1</xref>

<xref rid="cor1" ref-type="corresp"></xref>

</contrib>

<contrib contrib-type="author">

<name><surname>Filteau</surname>
<given-names>Suzanne</given-names>
</name>

<xref rid="aff2" ref-type="aff">2</xref>

</contrib>

<aff id="aff1">

<label><sup>1</sup>
</label>

<institution>Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine</institution>
, <addr-line>England</addr-line>

</aff>

<aff id="aff2">

<label><sup>2</sup>
</label>

<institution>Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine</institution>
, <addr-line>England</addr-line>

</aff>

</contrib-group>

<author-notes>

<corresp id="cor1">Reprints or correspondence: Rachel Peletz Department of Infectious and Tropical Diseases London School of Hygiene and Tropical Medicine Keppel St London WC1E 7HT UK (<email>Rachel.Peletz@lshtm.ac.uk</email>
)</corresp>

</author-notes>

<pub-date pub-type="ppub">

<day>1</day>

<month>5</month>

<year>2010</year>

</pub-date>

<volume>201</volume>

<issue>9</issue>

<fpage>1441</fpage>

<lpage>1442</lpage>

<copyright-statement>© 2010 by the Infectious Diseases Society of America</copyright-statement>

<copyright-year>2010</copyright-year>

</article-meta>

</front>

<body>

<p><bold>To the Editor</bold>
 —Kuhn and Aldrovandi [<xref rid="r1" ref-type="bibr">1</xref>
] offer insight on the Kisumu Breastfeeding Study (KiBS) presented by Harris and colleagues [<xref rid="r2" ref-type="bibr">2</xref>
]. The study examined the effect of a household water treatment intervention on diarrheal disease in infants born to human immunodeficiency virus (HIV) —infected Kenyan mothers. A co-hort of infants in households who re-ceived water treatment had a lower in-cidence of diarrhea before and after weaning and a similar incidence of di-arrhea during rapid weaning at 6 months, compared with a cohort of infants in households that received no water treatment.</p>

<p>We agree that unsafe water “takes on even greater salience in the context ofma-ternal HIV infection” [<xref rid="r1" ref-type="bibr">1</xref>
]. Many HIV-infected women choose to avoid breast-feeding or practice early weaning to pre-vent HIV transmission through breast milk. However, we disagree that the KiBS provides “sobering caution about the limits of water quality interventions” and that “early weaning...is the most likely reason why the KiBS intervention had only limited effectiveness” [<xref rid="r1" ref-type="bibr">1</xref>
]. In addition to ideas presented by both sets of authors [<xref rid="r1" ref-type="bibr">1</xref>
, <xref rid="r2" ref-type="bibr">2</xref>
], we would like to discuss the considerable differences in supplemental feeding in the 2 cohorts and the subsequent implica-tions for the weaning process. In partic-ular, we will examine the differences be-tween “early” and “abrupt” weaning.</p>

<p>There were differences in supplemental feeding practices between the 2 KiBS co-horts that may have influenced the lack of effect during weaning. In the control cohort, a median proportion of 25% re-ceived supplemental feedings before 6 months compared to a median of 0% in the intervention cohort [<xref rid="r1" ref-type="bibr">1</xref>
]. Therefore, more of the control infants had already been exposed to supplemental feedings before the official weaning period, which im-plies that weaning may have been less abrupt among the control infants than among the intervention infants.</p>

<p>Both sets of authors [<xref rid="r1" ref-type="bibr">1</xref>
, <xref rid="r2" ref-type="bibr">2</xref>
] attributed the diarrhea at weaning to “noninfectious etiologies,” as an explanation for why there were no benefits from improved wa-ter quality during the period of rapid weaning. Supporting this view is the lower risk of diarrhea for the cohort with household water treatment after the period of weaning, even though water-borne path-ogens were presumably similar to those during the weaning period. Although the lack of benefit around weaning was at-tributed to early weaning [<xref rid="r1" ref-type="bibr">1</xref>
], the actual problem may be due to the abrupt wean-ing that was practiced in this study, which is known to increase maternal morbidity [<xref rid="r3" ref-type="bibr">3</xref>
]. The early weaning in livestock studies cited as evidence of increased morbidity [<xref rid="r1" ref-type="bibr">1</xref>
] generally involves abrupt removal of offspring from the dam; this is known to be stressful for the offspring, so animal science researchers are investigating alternatives [<xref rid="r4" ref-type="bibr">4</xref>
, <xref rid="r5" ref-type="bibr">5</xref>
].</p>

<p>The need to abruptly wean infants of HIV-infected mothers was inferred on the assumption that the association between mixed feeding and increased HIV transmission was causal. However, our work in Zambia suggests that both mixed feeding (ie, early cessation of exclusive breast-feeding) and increased risk of HIV transmission are secondary to maternal illness [<xref rid="r6" ref-type="bibr">6</xref>
, <xref rid="r7" ref-type="bibr">7</xref>
]. The World Health Organization (WHO) 2000 HIV and infant recommen-dations [<xref rid="r8" ref-type="bibr">8</xref>
], contrary to the claim made by the KiBS authors [<xref rid="r2" ref-type="bibr">2</xref>
], did not fully en-dorse abrupt weaning, recognizing the limitations of the data and the problems of abrupt weaning. Furthermore, a more recent large study [<xref rid="r9" ref-type="bibr">9</xref>
] did not find a sig-nificantly higher transmission among infants that were not infected with HIV at 6 weeks (the usual cutoff for in utero and peripartum transmission) who received mixed feedings and infants who were exclusively breast-fed, perhaps because of generally better maternal healthcare. Therefore, it is possible that abrupt wean-ing may be an unnecessary stress that masked the effect of the water intervention in the KiBS.</p>

<p>The results of the KiBS are not as “sobering” as suggested [<xref rid="r1" ref-type="bibr">1</xref>
]. The study showed significant reductions in cases of diarrhea in infants before and after wean-ing [<xref rid="r2" ref-type="bibr">2</xref>
]. For most HIV-infected women, weaning should be earlier than advised for uninfected women because of the on-going risk of HIV transmission via breast milk. What feeding practices are best for infants of HIV-infected women in the second half of infancy and beyond are not clear and will depend on the woman's health [<xref rid="r10" ref-type="bibr">10</xref>
] and the familys environment and socioeconomic situation. We believe household water treatment has the potential to play a considerable role in infant feeding decisions for HIV-infected mothers.</p>

</body>

<back>

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<article-title>Mother-to-child transmission ofHIV-1 infec-tion during exclusive breastfeeding in the first 6 months oflife: an intervention cohort study</article-title>

<source>Lancet</source>

<year>2007</year>

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<name><surname>Kuhn</surname>
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<name><surname>Aldrovandi</surname>
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<article-title>Differential effects of early weaning for HIV-free survival of children born to HIV-infected mothers by severity of maternal disease</article-title>

<source>PLoS ONE</source>

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<fn fn-type="conflict">

<p>Potential conflicts of interest: R.P. is writing a doctoral dissertation on household water treatment and infant feeding by HIV-infected women, funded in part by Vestergaard Frandsen SA, a supplier of water treatment products. S.F. is cosupervisor of this PhD.</p>

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