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Exclusive Breast-Feeding and HIV Transmission

Exclusively breast-fed infants of HIV-infected mothers were less likely to be infected at 6 months than were similar infants who consumed solids or nonhuman milk.

HIV can be transmitted via breast-feeding, but in developing countries, not breast-feeding is associated with increased infant mortality from diarrhea and other diseases.

In South Africa, pregnant women were enrolled in a nonrandomized cohort study to assess HIV transmission and infant survival by type of infant feeding. They received single-dose nevirapine, counseling about feeding options, and postnatal home visits by counselors. The feeding options were exclusive breast-feeding, starting from birth; replacement feeding (nonhuman milk, with or without solids); and mixed breast-feeding (breast milk plus nonhuman milk, other liquids, or solids).

Of the 1372 HIV-infected women, 1132 (83%) chose exclusive breast-feeding. The median duration of exclusive breast-feeding was 159 days (67% for 3 months; 40% for 6 months). Among exclusively breast-fed infants who were HIV-negative at or after 6 weeks, the cumulative risk for infection after 5 months (i.e., at about 6 months of age) was 4%. Infants who received solids along with breast milk were nearly 11 times more likely than exclusively breast-fed infants to become HIV-infected. Infants born to mothers with CD4 counts <200 cells/mm³ were more likely to become HIV infected or to die than were those born to mothers with counts >500 cells/mm³. Overall mortality at 3 months was more than twice as high with replacement feeding as with exclusive breast-feeding (15% vs. 6%).

Comment: This study provides strong support for exclusive breast-feeding in certain settings and reaffirms that breast-feeding women with low CD4-cell counts are important targets for antiretroviral therapy. Exclusive breast-feeding may provide benefit by protecting the infant’s intestinal mucosa, thus providing a better barrier against HIV, and by diminishing the mother’s risk for breast-health problems, which are associated with increased breast-milk viral load. The authors and editorialists note the need to strengthen support for breast-feeding and to make feeding recommendations appropriate to local circumstances.

— Mary E. Wilson, MD

Published in Journal Watch Infectious Diseases April 4, 2007

Citation(s):

Coovadia HM et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: An intervention cohort study. Lancet 2007 Mar 31; 369:1107-16.

• Medline abstract (Free)

Holmes WR and Savage F. Exclusive breastfeeding and HIV. Lancet 2007 Mar 31; 369:1065-6.

• Medline abstract (Free)

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