Early ReportInfluence of infant-feeding patterns on early mother-to-child transmission of HIV-1 in Durban, South Africa: a prospective cohort study*
Introduction
Since the discovery that HIV-1 can be transmitted through breastfeeding, several policy recommendations have been developed,1, 2 which are expected to have a global impact on maternal and infant health. Whether prevention of HIV-1 infection through avoidance of breastfeeding will in practice outweigh the adverse effects of not breastfeeding has yet to be discovered. Breastfeeding by HIV-1-infected women in more-developed countries has virtually ceased3 and in less-developed countries many thousands of seropositive women and women who believe they may be HIV-1 infected are expected to avoid breastfeeding. The cultural diffusion theory raises the possibility that a loss of confidence in breastfeeding will spread to all women.4
Advocates of child care consider breastfeeding to be one of the principal gains to current maternal and child health, regained through long-standing campaigns to protect mother and infant wellbeing. The reason why breastfeeding is believed to be pre-eminent in human nutrition derives from its well-recognised nutritional, immunological, social, psychological, and nurturing benefits, which are especially important in the first 3 months.5
Analyses of HIV-1 transmission via breastmilk are flawed because they have failed to account for the effects of different types of breastfeeding practices: exclusive or mixed breastfeeding (without or with water, other fluids, and foods that might contaminate and injure the immature gastrointestinal tract).6 Two studies have attempted to examine the effect of different breastfeeding patterns on mother-to-child transmission,7, 8 but both have limitations. The most widely quoted meta-analysis on the risks of mother-to-child transmission by breastfeeding6 depended on studies with small sample sizes, short breastfeeding durations, and studies that do not distinguish exclusive from mixed breastfeeding.
We prospectively examined the impact of different patterns of breastfeeding on mother-to-child transmission of HIV-1 at 3 months of age.
Section snippets
Design
The mother-infant pairs enrolled in this study were participating in a vitamin A intervention trial to reduce the rate of mother-to-child transmission of HIV-1. The study took place at antenatal clinics of two hospitals in Durban, South Africa (King Edward VIII Hospital and McCord Hospital). Women were recruited between July, 1995, and April, 1998, and were randomly assigned vitamin A (daily supplement containing 5000 IU retinyl palmitate and 30 mg β-carotene) or placebo. Women started
Study sample
661 women recruited into the vitamin A trial were known to have had a liveborn infant at one of the two study hospitals (631 women had singletons, 28 women had twins, and two women delivered a single infant after death of the co-twin in utero; figure). Among the 631 singletons, 79 (12·5%) were not followed up for long enough to establish their feeding practices, and three were followed up but had no HIV-1 test results available. The remaining 549 singletons were included in the analysis. Those
Discussion
Our results do not accord with conventional wisdom because they suggest that the vertical transmission of HIV-1 through breastmilk is dependent on the pattern of breastfeeding and not simply on all breastfeeding. Exclusive breastfeeding carries a significantly lower risk (almost half the risk) of mother-to-child transmission of HIV-1 than mixed feeding. Although the risks of HIV-1 transmission associated with non-exclusive breastfeeding seem to be substantial (risk of HIV-1 infection by 3
References (26)
- et al.
Risk of human immunodeficiency virus type 1 transmission through breastfeeding
Lancet
(1992) - et al.
Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial
Lancet
(1999) - et al.
Late postnatal transmission of HIV-1 in Abidjan, Côte d'Ivoire
Lancet
(1997) - et al.
International multicentre pooled analysis of late postnatal mother-to-child transmission of HIV-1 infection
Lancet
(1998) Administration of zidovudine during late pregnancy and delivery to prevent perinatal HIV transmission—Thailand, 1996–1998
MMWR Morb Mortal Wkly Rep
(1998)HIV and infant feeding. A review of HIV transmission through breastfeeding. UNAIDS/WHO Joint United Nations Programme on HIV/AIDS (UNAIDS)
(June 1998)- et al.
Uptake of interventions to reduce mother-to-child transmission of HIV in the United Kingdom and Ireland
AIDS
(1997) - et al.
Review of the epidemiological evidence for an association between infant feeding and infant health
Pediatrics
(1984) Breastfeeding: a guide for the medical profession
(1994)- et al.
Breastfeeding by HIV-1-infected women and outcome in their infants: a cohort study from Durban, South Africa
AIDS
(1997)
Infant feeding and risk of mother-to-child transmission of HIV-1 in Sao Paulo State, Brazil. Sao Paulo Collaborative Study for vertical transmission of HIV-1
J Acquir Immune Defic Syndr Hum Retrovirol
Breastfeeding and complementary feeding practices in a low socio-economic urban and a low socio-economic rural area
S Afr J Food Sci Nutr
Simultaneous determination of retinol and alpha-tocopherol in serum or plasma by liquid chromatography
Clin Chem
Cited by (0)
- *
Members listed at end of paper