XVIII International AIDS Conference


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Practices of offering a child prechewed or orally prewarmed food: the NISDI perinatal (LILAC) cohort in Latin America

A. Gaur1, L. Freimanis-Hance2, K. Dominguez3, C. Mitchell4, J. Menezes5, M. Mussi-Pinhata6, M. Peixoto7, J. Alarcon8, D. Coelho9, J. Read10

1St. Jude Children's Research Hospital, Memphis, United States, 2Westat, Rockville, United States, 3Centers for Disease Control and Prevention (CDC), Atlanta, United States, 4University of Miami Miller School of Medicine, Miami, United States, 5Hospital dos Servidores do Estado, Rio de Janeiro, Brazil, 6Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil, 7Hospital Femina, Porto Alegre, Brazil, 8University of San Marcos, Lima, Peru, 9Irmandade de Santa Casa de Misericordia, Porto Alegre, Brazil, 10PAMA-CRMC-NICHD, National Institutes of Health, Bethesda, United States

Background: Mother-to-child transmission of HIV has been associated with prechewing of an infant's food by an HIV-infected caregiver. We assessed awareness of prechewing and orally prewarming food before offering it to an infant amongst HIV-infected pregnant women and clinical site investigators in Latin America.
Methods: HIV-infected pregnant women at 12 sites in Argentina, Brazil, and Peru, followed as part of a prospective cohort study [the NISDI Perinatal (LILAC) cohort], were administered a screening survey during pregnancy about knowledge and practice of prechewing and prewarming of infant foods, and cautioned against these feeding practices. Survey responses were tabulated, and stratified by country. In addition, NISDI investigators were surveyed regarding their knowledge of these practices.
Results: All 401 women enrolled in the cohort during 2008-2009 were interviewed during pregnancy. 32% had heard about prechewing (51% from Argentina, 29% from Brazil, 36% from Peru), 21% reported knowing someone who prechewed for infants, and 4% reported prechewing in the past. Respondents reported having heard about prewarming of food (17%), knowing someone who did this for infants (12%), and having practiced it in the past (3%). Respondents who reported knowing someone who prechewed food were 12 times more likely to also know someone who prewarmed food. Prior to learning of the study results, few site investigators reported their patients would be aware of these feeding practices (prechewing:1; prewarming:2).
Conclusions: The practice of prechewing food, a risk factor for HIV transmission, is not uncommon in Latin America. Although less prevalent than prechewing, prewarming of food may share the same risk as prechewing in exposing the child to blood from an HIV-infected adult. Infant caregivers who are HIV-infected should be routinely cautioned against these practices. Site investigator responses underscore that healthcare providers could be missing information about cultural practices which patients may not report unless specifically asked.

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