Research to date has produced conflicting evidence regarding the effects of breast-feeding on maternal mortality in women with HIV.

In a study reported in the January 15, 2007 Journal of Infectious Diseases, HIV positive women in Africa were enrolled during pregnancy and received short-course AZT to prevent mother-to-child transmission of the virus. HIV RNA levels and CD4 cell counts were measured at baseline and at months 1, 3, 6, 12, 18, and 24 post-partum; results were compared for women who breast-fed their infants and those who fed formula.

Results

• Of 296 women enrolled, 198 women breast-fed and 98 fed formula.

• At baseline, formula-feeding women had a higher education level and a higher prevalence of HIV-related illness than breast-feeding women.

• The groups did not differ with respect to baseline CD4 cell counts or HIV viral loads.

• Between months 1 and 24 post-partum, CD4 cell counts decreased by 3.9 cells/mm3 per month (P < 0.001).

• HIV RNA levels increased by 0.005 log10 copies/mL per month (P = 0.03).

• Body mass index (BMI) decreased by 0.03 kg/m2 per (P < 0.001).

• The rate of CD4 cell decline was higher among breast-feeding mothers compared with those who never breast-fed (7 vs 4 cells/mm3 per month).

• BMI decreased more rapidly in breast-feeding women (P = 0.04).

• HIV RNA levels and mortality rates did not differ significantly between breast-feeding and formula-feeding women.

Conclusion

"Breast-feeding was associated with significant decreases in CD4 cell counts and BMI," the authors concluded. "HIV-1 RNA levels and mortality were not increased, suggesting a limited adverse impact of breast-feeding in mothers receiving extended care for HIV-1 infection."

1/16/07

References
P A Otieno, E R Brown, D A Mbori-Ngacha, and others. HIV-1 Disease Progression in Breast-Feeding and Formula-Feeding Mothers: A Prospective 2-Year Comparison of T Cell Subsets, HIV-1 RNA Levels, and Mortality. Journal of Infectious Diseases 195(2): 220-229. January 15, 2007.

C M Wilfert and M G Fowler. Balancing Maternal and Infant Benefits and the Consequences of Breast-Feeding in the Developing World during the Era of HIV Infection. Journal of Infectious Diseases 195(2): 165-167. January 15, 2007.

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