Exclusive Breastfeeding May Reduce Postnatal HIV Transmission

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Early exclusive breastfeeding reduced postnatal transmission of HIV and increased HIV-free survival in a large trial conducted in Zimbabwe.

International guidance currently recommends avoidance of all breastfeeding by HIV-infected mothers when replacement feeding is acceptable and safe, but such replacement feeding is commonly unavailable in Africa, the authors report in the April 29th issue of AIDS.

Dr. Jean H. Humphrey from the ZVITAMBO Project, Harare, Zimbabwe and colleagues collected information on infant feeding practices and measured associated infant infections and deaths in a trial examining the efficacy of postpartum vitamin A supplementation in the greater Harare area of Zimbabwe.

Postnatal transmission of HIV was lowest in infants with exclusive breastfeeding (5.1 per 100 child-years), the authors report, and increased with predominant breastfeeding (6.7 per 100 child-years) and mixed breastfeeding (10.5 per 100 child-years).

Mortality rates at 18 months were substantially lower in the exclusive breastfeeding group (1.96%) than in the predominant breastfeeding (3.57%) and mixed breastfeeding (4.17%) groups, the report indicates.

Low maternal CD4 cell counts, poor maternal nutritional status, and severe maternal anemia at baseline were also important predictors of postnatal transmission, the researchers note.

Unfortunately, the results indicate, only 7.6% of infants were exclusively breastfed for at least 3 months, whereas 23.8% received predominant breastfeeding and 68.6% received mixed breastfeeding for at least 3 months.

"Our findings underscore the importance of supporting exclusive breastfeeding, particularly in areas of high HIV prevalence, where many women do not know their HIV status, and among HIV-positive mothers who choose to breastfeed," the authors conclude.

"The early introduction of non-human milks and solid foods should be strongly discouraged because it increases the risk of HIV infection for babies of HIV-positive women and the risk of diarrhea and respiratory infections for all babies."

These findings support those of earlier studies.

05/18/05

AIDS 2005;19:699-708.