Exclusive breast-feeding: does it have the potential to reduce breast-feeding transmission of HIV-1?

Nutr Rev. 2000 Nov;58(11):333-40. doi: 10.1111/j.1753-4887.2000.tb01830.x.


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.

Publication types

  • Review

MeSH terms

  • Breast Feeding*
  • Female
  • HIV Infections / transmission*
  • HIV-1 / physiology*
  • Humans
  • Infant
  • Infant Food
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical*
  • Intestinal Mucosa / immunology*
  • Intestinal Mucosa / microbiology
  • Intestinal Mucosa / physiology
  • Lactation
  • Milk, Human / immunology*
  • Milk, Human / virology
  • Risk Factors
  • Viral Load