Prolonged breast-feeding and mortality up to two years post-partum among HIV-positive women in Zambia

Abstract

Background: A previously reported association between prolonged lactation and maternal mortality has generated concern that breast-feeding may be detrimental for HIV-positive women.

Methods: As part of a trial conducted in Lusaka, Zambia, 653 HIV-positive women were randomly assigned either to a counseling program that encouraged abrupt cessation of breast-feeding at 4 months (group A) or to a program that encouraged prolonged breast-feeding for the duration of the woman's own informed choice (group B). We examined whether mortality up to 2 years post-partum increased with breast-feeding for a longer duration.

Results: There was no difference in mortality 12 months after delivery between 326 HIV-positive women randomly assigned to short breast-feeding [group A: 4.93%; 95% confidence interval (CI), 2.42-7.46] versus 327 women assigned to long breast-feeding (group B: 4.89%; 95% CI, 2.38-7.40). Analysis based on actual practice, rather than random assignment, also demonstrated no increased mortality due to breast-feeding.

Conclusions: Although HIV-related mortality was high in this cohort of untreated HIV-positive women, prolonged lactation was not associated with increased mortality.

Figures

Fig. 1. Mortality after delivery among 653 HIV-positive women in Lusaka, Zambia

(a) Kaplan–Meier curves for women randomized to cessation of breastfeeding at 4 months (group A: dashed line) or to continued breastfeeding (group B: solid line) and (b) Kaplan–Meier cumulative probabilities of mortality at 4,12, and 24 months post-delivery among women randomized to groups A and B. Group A, early cessation of breast-feeding; group B, continued breast-feeding. CI, confidence interval.