Modeling the impact of breast-feeding by HIV-infected women on child survival.

This study models the survival outcomes of children born to HIV-infected (human immunodeficiency virus) women who are breast-fed, bottle-fed, and wet-nursed. It is estimated that, given the relative risk of alternatives to maternal milk in developing countries, the probability of HIV transmission via breast milk would need to be at least .12 in a community with an under five child mortality rate from non-HIV causes of 100/1000 live births and at least .27 in a community with a rate of 200/1000 before alternative feeding practices should be recommended even to the known HIV-infected mother who has an available feeding alternative with a relative risk of 2:1. While such a low relative risk may be achievable with wet nursing, most studies report a relative risk of at least 3:1 for bottle feeding. A sensitivity analysis is conducted around the relative risk of child mortality from non-HIV causes associated with different feeding practices. While the critical transmission rate does not vary significantly with a rate of false positives as high as 20 percent on the HIV screening test, the critical transmission rate is very sensitive to the availability of HIV screening. In communities where the HIV prevalence rate among mothers reaches 40 percent, breast-feeding should still be recommended in the absence of HIV screening unless HIV transmission via breast milk surpasses 30 percent.