AIDS origins and brf/(wasRe: Dr. Phil Show/OT Birthday Wish!)

January 30, 2007

>http://video.google.fr/videoplay?docid=-266890172132861595 & q=the+other+side+of+\

aids

this is an excellent film made on this very subject if you have the

time to watch it--1 1/2 hours...heart-wrenching to see mothers

speaking of being forced to poison their healthy babies with AZT.

plus info about HIV and AIDS and breastfeeding with HIV.

here is an article too...

http://www.medscape.com/viewarticle/503736

Medscape Medical News

Exclusive Breast-feeding May Reduce Risk of Postnatal HIV Transmission

CME

News Author: Laurie Barclay, MD

CME Author: Désirée Lie, MD, MSEd

Disclosures

To earn CME credit, read the news brief along with the CME information

that follows and answer the test questions.

Release Date: April 22, 2005; Valid for credit through April 22, 2006

April 22, 2005 — Exclusive breast-feeding (EBF) reduces the risk of

postnatal transmission (PNT) of HIV, according to the results of a

study published in the April issue of AIDS. These findings support an

earlier observation about the benefits of breast-feeding.

" International guidance currently states that when replacement feeding

is acceptable, feasible, affordable, sustainable and safe, the

avoidance of all breastfeeding by HIV-infected mothers is

recommended, " write J. Iliff, MD, and colleagues from the

ZVITAMBO study group in Borrowdale, Harare, Zimbabwe. " The promotion

of exclusive breastfeeding (EBF) to reduce the postnatal transmission

(PNT) of HIV is based on limited data. In the context of a trial of

postpartum vitamin A supplementation, we provided education and

counseling about infant feeding and HIV, prospectively collected

information on infant feeding practices, and measured associated

infant infections and deaths. "

In this study, 14,110 mother-newborn pairs were enrolled, randomized

to a vitamin A treatment group after delivery, and followed up for two

years. At baseline, six weeks and three months, the investigators

asked the mothers whether they were still breast-feeding, and whether

they had given the infant any of 22 liquids or foods. Breast-fed

infants were classified as EBF, predominant breast-fed (PBF), or mixed

breast-fed (MBF).

Of 4,495 mothers who were HIV positive at baseline, 2,060 provided

complete feeding information and had babies who were alive with

negative findings on polymerase chain reaction (PCR) at six weeks. All

infants began breast-feeding.

Overall PNT, which was defined by a positive HIV test result after the

six-week test finding was negative, was 12.1%. Of these, 68.2%

occurred after six months. Compared with EBF, early MBF was associated

with a greater risk of PNT at six months (4.03; 95% confidence

interval [CI], 0.98 - 16.61), 12 months (3.79; 95% CI, 1.40 - 10.29),

and 18 months (2.60; 95% CI, 1.21 - 5.55). Compared with EBF, PBF was

associated with a trend toward greater PNT risk at six months (2.63;

95% CI, 0.59 - 11.67), 12 months (2.69; 95% CI, 0.95 - 7.63), and 18

months (1.61; 95% CI, 0.72 - 3.64).

Study limitations include lack of data on maternal blood viral load

during breast-feeding or on the frequency or quantity of non–breast

milk foods and liquids consumed by infants, and feeding patterns

self-selected by mothers, raising the possibility of reverse causality.

" EBF may substantially reduce breastfeeding-associated HIV

transmission, " the authors write. " Screening mothers for CD4 cell

counts could help to identify infants at highest risk of PNT so that

alternative feeding methods (or antiretroviral therapy for the mother)

can be considered. "

The Canadian International Development Agency U.S. Agency for

International Development, the Bill and Melinda Gates Foundation, the

Rockefeller Foundation, BASF, and the Support for Analysis and

Research in Africa (SARA) project supported the ZVITAMBO project.

AIDS. 2005;19:699-708

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

* Describe the prevalence of and risk factors for PNT of HIV.

* Evaluate the effect of early EBF, PBF, and MBF on PNT.

Clinical Context

Each year, 700,000 infants acquire HIV from their mothers. About

280,000 (40% of total mother-to-infant transmission) are infected

through breast-feeding. International guidance currently recommends

the avoidance of EBF when replacement feeding is safe and available.

In Africa, up to 40% of prenatal women are infected with HIV. Despite

infant counseling about feeding practices, replacement feeding that is

acceptable, safe, affordable, and sustainable is uncommon, according

to the current authors. One study by Coutsoudis and colleagues

published in the Aug. 7, 1999, issue of the Lancet has demonstrated

previously that infants EBF for at least three months had a lower risk

of HIV transmission from their mothers than those with MBF. The

current study is a prospective trial to examine the relationship

between mother-infant rate of PNT of HIV and patterns of early

feeding, with up to 24 months of follow-up. It was part of a larger

trial (ZVITAMBO) designed to measure the impact of a single dose of

postpartum vitamin A supplementation on maternal and neonatal outcomes.

Study Highlights

* Mother and baby pairs from 14 maternity clinics and hospitals in

1 area of Zimbabwe were included if the baby was a singleton with

birth weight of 1,500 g or more and permission for HIV testing was

granted. Although mothers could be given their HIV results, receiving

HIV results was not a condition of inclusion in the study.

* 14,110 women were randomized to 1 of 4 vitamin A treatment

groups within 96 hours of delivery. HIV test, CD4 count, and

hemoglobin testing were performed. HIV testing used two enzyme-linked

immunosorbent assay (ELISA) tests done in parallel, and the Western

blot assay was used to resolve conflicting results.

* Infant HIV testing by ELISA was performed at birth and at

follow-up, and positive infection was defined as 2 consecutive

positive samples.

* Follow-up occurred at 6 weeks, 3 months, and 3-monthly intervals

up to 24 months. Infant-feeding practices were elicited by detailed

dietary history using World Health Organization (WHO) definitions of

EBF, PBF, and MBF. Blood assays were performed, and women received

free clinical care, education about safe practices for infant

nutrition, and psychosocial counseling.

* Treatment status for women with HIV was not described.

* PNT risks at 6, 12, and 18 months were calculated for the 3

feeding groups, and survival rates to 18 months were estimated using

Kaplan-Meier methods.

* 31.9% of mothers (n = 4,495) were HIV positive at enrollment.

2.8% of infants born to HIV-positive mothers had no data for

follow-up. 2,060 infants were included in the final analysis after

accounting for deaths before 6 months and those missing PCR status at

6 weeks. Those in the analysis had higher birth weights than those not

included.

* 99%, 94%, and 59% of mothers were still breast-feeding at 6, 12,

and 18 months, respectively. Only 7.6% of babies had EBF by 3 months

vs 23.8% with PBF and 68.6% with MBF.

* EBF infants had higher birth weights (> 2,500 g) than other infants.

* Between 6 weeks and 18 months, 199 infants became HIV infected,

and 48 died with a final negative PCR result (ie, not related to HIV

infection), totaling 247 HIV infection or death events. Total number

of deaths with or without HIV was 3, 16, and 52 in the EBF, PBF, and

MBF groups, respectively.

* PNT at 6, 12, and 18 months was 3.9%, 7.7%, and 12.1%,

respectively. 68% of all PNT occurred after 6 months.

* At 12 months, MBF and PBF carried a significantly greater risk

of PNT vs EBF.

* Overall PNT rate was 9.2 per 100 child-years of breast-feeding

compared with a previous meta-analysis showing a rate of 8.9 per

child-year of breast-feeding from 9 other African studies. PNT rates

were 5.1, 6.7, and 10.5 per 100 child-years of breast-feeding for EBF,

PBF, and MBF, respectively.

* Maternal CD4 count was an important predictor of PNT. Mothers

with CD4 counts less than 200 cells/µL had a PNT rate of 33.7%.

* Maternal nutritional status was associated positively with

infant outcomes. Severe maternal anemia was a positive predictor of

PNT with greatest risk in the first 6 months.

* MBF was associated with a fourfold increase in PNT and threefold

increase in risk of PNT plus death at 6 months compared with EBF (P <

..008). Early PBF was associated with a 1.6-fold increase in PNT and

2.6-fold increased risk of PNT and death at 6 months. Risk declined at

18 months for both groups.

* The adjusted hazard ratio for PNT at 18 months for MBF compared

with EBF was 3.19 (95% CI, 1.30 - 7.82), ie, a risk reduction of 61%,

suggesting that the protective effect of EBF may have been even

greater among women in whom PNT risk was highest.

* Vitamin A supplementation was not associated with PNT risk of

death at any time.

Pearls for Practice

* In Africa, up to 40% of prenatal women are HIV infected, and

counseling includes avoidance of EBF. Risk factors for PNT include

poor maternal nutrition, maternal anemia, and low maternal CD4 count.

* Compared with MBF and PBF, early EBF is associated with lower

rates of PNT and death at six months, and the effect persists at 18

months.

> To be honest, Ingrid, I didn't know it was OK for HIV+ mothers to bf

their babies. How is this so?..............Anita

>

January 30, 2007

Thank you........Anita

christine <christineniblo@...> wrote: