Local centre proves 'surrogate' HIV infection

The Africa Centre for Health and Population Studies, Zululand's HIV-AIDS research hub based near Mtubatuba, has revealed the first proven HIV surrogate transmission case in South Africa.

This breakthrough research using DNA sequencing was published in respected UK medical journal The Lancet last week. In November 2009 a woman brought her 74 day-old infant to a Bloemfontein hospital and discovered the child was infected with HIV, in spite of her own negative status. According to the report it was initially suspected that the transmission was nosocomial, meaning that it had occurred in hospital.

However, when social workers interviewed the mother they discovered that the mother?s sister had breastfed the baby intermittently from six weeks of age. The sister and her five month-old child were subsequently found to be HIV positive. DNA sequencing confirmed the sister had unknowingly infected her sister?s child. ' This was a devastating case for a family in South Africa,' said senior researcher Tulio de Oliveira, ' The aunt breastfed the infant out of great kindness so the mother could go back to work. ' However, this ended up in tragedy,' he said.

De Oliveira explained that the use of DNA analysis enabled Africa Centre to prove the virus infecting the aunt, cousin and infant were linked and simultaneously prove the innocence of medical personnel who had cared for the baby when it was born. Formula removal concerns ' This case highlights the need for safe and appropriate infant feeding practices in Africa, including HIV testing of all breastfeeding surrogates and mothers. South Africa has one of the highest HIV/AIDS epidemics and one of the lowest exclusive breastfeeding rates in the world, where fewer than 10% of infants are exclusively breastfeed. However, even in the light of the AIDS epidemic, evidence has shown that mixed breast and formula feeding and exclusive formula feeding has a higher impact on infant?s mortality and morbidity'.

' Research at Africa Centre has shown that the mixing of breast and formula feeding of infants by HIV-positive mothers has been shown to increase a baby's risk of contracting HIV from breast milk as artificial formulas strip the child?s intestines of natural defences to subsequent infection. Formula feeding also potentially exposes infants to contaminated water used to mix the formula, resulting in diarrhea and other conditions. Health authorities are now encouraging exclusive breastfeeding, even for children of HIV-positive mothers, for up to six months. ' However, HIV-exposed infants must receive antiretrovirals to prevent mother-tochild transmission,' said De Oliveira. In order to increase the rate of exclusive breastfeeding, the Health Ministry of SA recently announced that formula feeding should be removed from all public health facilities in the country.

'This policy is backed by the expanded use of antiretroviral drugs and a recent decrease of mother to child HIV transmission in the country. However, South Africa will have to work hard to ensure that public health facilities can identify the HIV status of all mothers and surrogate feeders and make sure that the HIV-exposed infant starts ARVs as soon as possible, as otherwise this new decision and policy could backfire'

Open access manuscript: Goedhals D, Rossouw I, Hallbauer U, Mamabolo M, de Oliveira T. The tainted milk of human kindness Lancet,380:702 (2012).

News date: 2012-08-24



Publication cited

Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study. Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L For IeDEA-SA, PLoS Medicine (2012), 9(9):e1001304.