Background: Women in developing countries have the difficult choice of balancing the risk of transmitting HIV through breast milk against the substantial benefits of breastfeeding. It is not known, however, whether the benefits of breastfeeding are the same when the mother is HIV-infected. Therefore, we examined the impact of breastfeeding on infections, growth and mortality in the infants of HIV-1-infected women.
Methods: Infants of HIV-1-positive women were followed from birth and at each visit they were examined, growth parameters were recorded and notes were made of feeding method, and of current and interim illnesses.
Results: Of the 43 HIV-infected and 90 non-infected infants for whom feeding data were available, 36 infants (27%) were exclusively breastfed, 76 (57%) received mixed feeding, and 21 (16%) received formula only. The HIV transmission rate was 39% in those exclusively breastfed, 24% in those fed exclusively on formula and 32% in those receiving mixed feeding [relative risk (RR), 7.39; 95% confidence interval (CI), 1.67-32.6 between the exclusive breast and formula only groups]. There was a stepwise increase in the transmission rate with duration of exclusive breastfeeding of 1, 2 and 3 months (45%, 64%, and 75%, respectively). Of the infected infants, seven (50%) exclusively breastfed, 13 (51%) of those on mixed feeds and none on formula only developed AIDS; exclusively breastfed infants had a slower rate of progression to AIDS (mean age, 7.5 months versus 5.0 months, P = 0.2242) than those on mixed feeds. Mortality (which occurred in the infected infants only) was 19% in the exclusively breastfed infants; 13% in those on mixed feeds and 0% in those exclusively formula-fed. The frequency of failure to thrive and episodes of diarrhoea and pneumonia were not significantly different between the three groups in both the infected and non-infected infants.
Conclusions: Exclusive breastfeeding by HIV-infected women does not appear to protect their infants against common childhood illnesses and failure to thrive, nor does it significantly delay progression to AIDS. The implication of the trend towards differential mortality rates according to feeding groups is uncertain and requires further investigation.
PIP: To determine whether breast feeding confers the same protective effects on child health and survival when the mother is infected with HIV, a prospective study was conducted of a cohort of 133 infants born in Durban, KwaZulu/Natal, South Africa, in 1990-93 and followed for up to 24 months. 36 infants (27%) were exclusively breast-fed, 76 (57%) received mixed feeds, and 21 (16%) received formula only. By 15 months of age, 43 infants were antibody-positive or had died from an HIV-related cause. The HIV transmission rate was 39% in those exclusively breast-fed, 24% in those fed formula only, and 32% in infants receiving mixed feeds. The relative risk of HIV transmission in exclusively breast-fed compared with entirely formula-fed infants was 7.39 (95% confidence interval, 1.67-32.6). The HIV transmission rate was 45% after 1 month of breast feeding, 64% after 2 months, and 75% after 3 months. Among HIV-infected infants, seven (50%) of those exclusively breast-fed, 13 (51%) of those on mixed feeds, and none on formula developed AIDS. However, exclusively breast-fed babies had, on average, a slightly slower rate of progression to AIDS (7.5 months) than those receiving both breast milk and formula (5.0 months). Mortality was 19% in exclusively breast-fed infants and 13% in those on mixed feeds; no infants in the formula-fed only group died. The frequencies of diarrhea, pneumonia, and failure to thrive did not differ between infected or non-infected infants in the three groups. These unexpected findings suggest that exclusive breast feeding by HIV-infected women does not protect infants against childhood illnesses or significantly delay progression to AIDS.