High uptake of exclusive breastfeeding and reduced early post-natal HIV transmission

Louise Kuhn, Moses Sinkala, Chipepo Kankasa, Katherine Semrau, Prisca Kasonde, Nancy Scott, Mwiya Mwiya, Cheswa Vwalika, Jan Walter, Wei-Yann Tsai, Grace M Aldrovandi, Donald M Thea, Louise Kuhn, Moses Sinkala, Chipepo Kankasa, Katherine Semrau, Prisca Kasonde, Nancy Scott, Mwiya Mwiya, Cheswa Vwalika, Jan Walter, Wei-Yann Tsai, Grace M Aldrovandi, Donald M Thea

Abstract

Background: Empirical data showing the clear benefits of exclusive breastfeeding (EBF) for HIV prevention are needed to encourage implementation of lactation support programs for HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study in Lusaka, Zambia, to test the hypothesis that EBF is associated with a lower risk of postnatal HIV transmission than non-EBF.

Methods and results: As part of a randomized trial of early weaning, 958 HIV-infected women and their infants were recruited and all were encouraged to breastfeed exclusively to 4 months. Single-dose nevirapine was provided to prevent transmission. Regular samples were collected from infants to 24 months of age and tested by PCR. Detailed measurements of actual feeding behaviors were collected to examine, in an observational analysis, associations between feeding practices and postnatal HIV transmission. Uptake of EBF was high with 84% of women reporting only EBF cumulatively to 4 months. Post-natal HIV transmission before 4 months was significantly lower (p = 0.004) among EBF (0.040 95% CI: 0.024-0.055) than non-EBF infants (0.102 95% CI: 0.047-0.157); time-dependent Relative Hazard (RH) of transmission due to non-EBF = 3.48 (95% CI: 1.71-7.08). There were no significant differences in the severity of disease between EBF and non-EBF mothers and the association remained significant (RH = 2.68 95% CI: 1.28-5.62) after adjusting for maternal CD4 count, plasma viral load, syphilis screening results and low birth weight.

Conclusions: Non-EBF more than doubles the risk of early postnatal HIV transmission. Programs to support EBF should be expanded universally in low resource settings. EBF is an affordable, feasible, acceptable, safe and sustainable practice that also reduces HIV transmission providing HIV-infected women with a means to protect their children's lives.

Trial registration: ClinicalTrials.gov NCT00310726.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Cumulative probability of testing HIV…
Figure 1. Cumulative probability of testing HIV positive by PCR through 4 months among 613 exclusively breastfed (EBF) infants and 121 non-exclusively breastfed (Non-EBF) infants born to HIV-infected women in Lusaka, Zambia.
Non-EBF was defined as giving the child any non-breast milk items (except prescribed medicines) in the past 24 hours or at least once per week at any time before 4 months.
Figure 2. Hazard rates of breastfeeding HIV…
Figure 2. Hazard rates of breastfeeding HIV transmission per month averaged over 4 month intervals through 24 months

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