Effect of breastfeeding on mortality among HIV-1 infected women: A randomised trial

University of Washington Seattle, Seattle, Washington, United States
The Lancet (Impact Factor: 45.22). 06/2001; 357(9269):1651-5. DOI: 10.1016/S0140-6736(00)04820-0
Source: PubMed


We have completed a randomised clinical trial of breastfeeding and formula feeding to identify the frequency of breastmilk transmission of HIV-1 to infants. However, we also analysed data from this trial to examine the effect of breastfeeding on maternal death rates during 2 years after delivery. We report our findings from this secondary analysis.
Pregnant women attending four Nairobi city council clinics were offered HIVtests. At about 32 weeks' gestation, 425 HIV-1 seropositive women were randomly allocated to either breastfeed or formula feed their infants. After delivery, mother-infant pairs were followed up monthly during the first year and quarterly during the second year until death, or 2 years after delivery, or end of study.
Mortality among mothers was higher in the breastfeeding group than in the formula group (18 vs 6 deaths, log rank test, p=0.009). The cumulative probability of maternal death at 24 months after delivery was 10.5% in the breastfeeding group and 3.8% in the formula group (p=0.02). The relative risk of death for breastfeeding mothers versus formula feeding mothers was 3.2 (95% CI 1.3-8.1, p=0.01). The attributable risk of maternal death due to breastfeeding was 69%. There was an association between maternal death and subsequent infant death, even after infant HIV-1 infection status was controlled for (relative risk 7.9, 95% CI 3.3-18.6, p<0.001).
Our findings suggest that breastfeeding by HIV-1 infected women might result in adverse outcomes for both mother and infant.

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    • "Postpartum weight changes have been noted among HIV-infected populations by feeding modality and duration . In Kenya, HIV-infected breastfeeding women experienced more weight loss than formula-feeders from the earliest post-natal visit through 5–9 months (Nduati et al. 2001). In Zambia, more women gained than lost weight between four and 24 months postpartum, but longerduration breastfeeding was associated with less weight gain (Murnane et al. 2010). "
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    ABSTRACT: Objective To determine the effect of infant feeding practices on postpartum weight change among HIV-infected and -uninfected women in South Africa. Methods In a non-randomised intervention cohort study of antiretroviral therapy-naïve women in South Africa, infants were classified as exclusive (EBF), mixed (MF) or non-breastfed (NBF) at each visit. We analysed infant feeding cumulatively from birth to 5 months using 24-hour feeding history (collected weekly for each of the preceding 7 days). Using generalised estimating equation mixed models, allowing for repeated measures, we compared postpartum weight change (kg) from the first maternal postpartum weight within the first 6 weeks (baseline weight) to each subsequent visit through 24 months among 2340 HIV-infected and -uninfected women with live births and at least two postpartum weight measurements. Results HIV-infected (−0.2 kg CI: −1.7 to 1.3 kg; P = 0.81) and -uninfected women (−0.5 kg; 95% CI: −2.1 to 1.2 kg; P = 0.58) had marginal non-significant weight loss from baseline to 24 months postpartum. Adjusting for HIV status, socio-demographic, pregnancy-related and infant factors, 5-month feeding modality was not significantly associated with postpartum weight change: weight change by 24 months postpartum, compared to the change in the reference EBF group, was 0.03 kg in NBF (95% CI: −2.5 to +2.5 kg; P = 0.90) and 0.1 kg in MF (95% CI: −3.0 to +3.2 kg; P = 0.78). Conclusion HIV-infected and -uninfected women experienced similar weight loss over 24 months. Weight change postpartum was not associated with 5-month breastfeeding modality among HIV-infected and -uninfected women.
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    • "Specifically, HIV-affected mothers are more likely to be socially disadvantaged in having lower household incomes (Marinda et al. 2007), and being widowed or separated from their spouse (Koyanagi et al. 2011), and more likely to be living under conditions of food insecurity (FI) (Bentley et al. 2005; Hadley & Patil 2006; Anema et al. 2009). FI is associated with maternal mental health (anxiety and depression) among Tanzanian women (Hadley & Patil 2006).These conditions, together with the effects of HIV infection, influence maternal nutritional status (Nduati et al. 2001). Knowledge of having HIV itself may cause depression and, subsequently, change maternal care practices (Mast et al. 2006). "
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    ABSTRACT: Children of HIV-infected mothers experience poor growth, but not much is understood about the extent to which such children are affected. The Research to Improve Infant Nutrition and Growth (RIING) Project used a longitudinal study design to investigate the association between maternal HIV status and growth among Ghanaian infants in the first year of life. Pregnant women in their third trimester were enrolled into three groups: HIV-negative (HIV-N, n = 185), HIV-positive (HIV-P, n = 190) and HIV-unknown (HIV-U, n = 177). Socioeconomic data were collected. Infant weight and length were measured at birth and every month until 12 months of age. Weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) z-scores were compared using analysis of covariance. Infant HIV status was not known as most mothers declined to test their children's status at 12 months. Adjusted mean WAZ and LAZ at birth were significantly higher for infants of HIV-N compared with infants of HIV-P mothers. The prevalence of underweight at 12 months in the HIV-N, HIV-P and HIV-U were 6.6%, 27.5% and 9.9% (P < 0.05), respectively. By 12 months, the prevalence of stunting was significantly different (HIV-N = 6.0%, HIV-P = 26.5% and HIV-U = 5.0%, P < 0.05). The adjusted mean ± SE LAZ (0.57 ± 0.11 vs. -0.95 ± 0.12; P < 0.005) was significantly greater for infants of HIV-N mothers than infants of HIV-P mothers. Maternal HIV is associated with reduce infant growth in weight and length throughout the first year of life. Children of HIV-P mothers living in socioeconomically deprived communities need special support to mitigate any negative effect on growth performance.
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    • "Besides this, the resting energy expenditure in HIV infected women has been shown to be higher than that in their HIV uninfected counterpart [21]. There was therefore some concern raised regarding the effect of breastfeeding on maternal health [22]. However, it was shown by Papathakis et al. that although HIV positive lactating mothers lost more weight and subcutaneous fat than the HIV negative women, there was no significant difference in their change in lean body mass [23]. "
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