Conditions that damage the mucous membrane of infants, such as oral thrush (Candida infection), may be associated with an increased risk of transmission through breastfeeding. It is difficult, however, to determine which is cause and which effect, since thrush may be a feature of early HIV-1 infection (Ekpini et al., 1997; Embree et al., 2000). Infant oral thrush can also cause nipple thrush and fissures. Damage to the intestinal mucous membrane can result from feeding with cow's milk, allergic reactions to complementary foods, and infections. Mode of feeding may affect the intestinal permeability of the young infant: infants who receive only breast milk may have a less permeable and therefore healthier lining of the gut than those who also receive other feeds. In the one study carried out to investigate this further, however, feeding mode was not associated with intestinal permeability in infants (measured with lactulose-mannitol ratios, i.e., dual sugars). Infants who had been diagnosed with HIV infection at 14 weeks, however, had higher permeability at six and 14 weeks than uninfected infants (Rollins et al., 2001).
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