From the Consensus Statement of the WHO HIV and Infant Feeding Technical Consultation group which met in Oct 2006. These are the findings there were recently reported on by the NY Times and Scientific American.

New evidence on HIV transmission through breastfeeding

• Exclusive breastfeeding for up to six months was associated with a
three to four fold decreased risk of transmission of HIV compared to
non-exclusive breastfeeding in three large cohort studies conducted
in Cτte d’Ivoire, South Africa and Zimbabwe.
• Low maternal CD4+ count, high viral load in breast milk and plasma,
maternal seroconversion during breastfeeding and breastfeeding
duration were confirmed as important risk factors for postnatal HIV
transmission and child mortality.
• There are indications that maternal HAART for treatment-eligible
women may reduce postnatal HIV transmission, based on programme
data from Botswana, Mozambique and Uganda; follow-up trial data
on the safety and efficacy of this approach, and on infant prophylaxis
trials, are awaited.

New evidence on morbidity and mortality
• In settings where antiretroviral prophylaxis and free infant formula
were provided, the combined risk of HIV infection and death by 18
months of age was similar in infants who were replacement fed from
birth and infants breastfed for 3 to 6 months (Botswana and Cτte
d'Ivoire).
• Early cessation of breastfeeding (before 6 months) was associated with
an increased risk of infant morbidity (especially diarrhoea) and
mortality in HIV-exposed children8 in completed (Malawi) and
ongoing studies (Kenya, Uganda and Zambia).
• Early breastfeeding cessation at 4 months was associated with reduced
HIV transmission but also with increased child mortality from 4 to 24
months in preliminary data presented from a randomized trial in
Zambia.
• Breastfeeding of HIV-infected infants beyond 6 months was associated
with improved survival compared to stopping breastfeeding in
preliminary data presented from Botswana and Zambia.


Improving infant feeding practices
• Improved adherence and longer duration of exclusive breastfeeding up
to 6 months were achieved in HIV-infected and HIV-uninfected
mothers when they were provided with consistent messages and
frequent, high quality counselling in South Africa, Zambia and
Zimbabwe.

New programme data
• UN HIV and infant feeding guidance is available and increasingly
used in policy-making in countries, but challenges in implementation
remain.
• Coverage and quality of the full range of interventions to prevent
mother-to-child transmission of HIV, including those related to infant
feeding counselling and support, is disturbingly low.
• Weak and poorly organized health services affect the quality of infant
feeding counselling and support. Inaccurate, insufficient, or nonexistent
infant feeding counselling has led to inappropriate feeding
choices by both HIV-infected and HIV-uninfected women.
• Scaling-up quality infant feeding counselling and support and related
interventions needs sustained and strong commitment and support
from international agencies and donors working in concert with
Ministries of Health.
• The sharp increase in deaths from diarrhoea and malnutrition in nonbreastfed
infants and young children during a recent diarrhoeal disease
outbreak in one country emphasizes the vulnerability of replacementfed
infants and young children, and the need for adequate follow-up
for all infants.
• Increasing access to early infant diagnosis in the first months of life
and to paediatric ARV treatment provides new opportunities for
postnatal infant feeding assessment, counselling, and follow-up
nutritional support.
• Multidisciplinary research, from basic science through clinical trial
and operational research, is still needed on identified priority issues,
including ways of making infant feeding options safer for HIV-exposed
infants.